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Admission rapid thrombelastography delivers real-time "actionable" data in pediatric trauma
Adam M Vogel1, Zayde A Radwan, Charles S Cox
1Division of Pediatric Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO 63110, USA. vogelam@wudosis.wustl.edu
Insights
Admission rapid thrombelastography (rTEG) in pediatric trauma correlates with conventional tests and predicts early transfusions, lifesaving interventions, and outcomes. This tool aids in guiding resuscitation for critically injured children.
Area of Science:
- Trauma Resuscitation
- Coagulation Monitoring
- Pediatric Critical Care
Background:
- Admission rapid thrombelastography (rTEG) is a real-time tool for evaluating trauma-induced coagulopathy.
- Its relationship with conventional coagulation tests (CCT) and early lifesaving interventions (LSI) in pediatric trauma is not well-established.
Purpose of the Study:
- To determine the correlation between rTEG parameters and CCT in pediatric trauma patients.
- To assess the ability of rTEG to predict early LSI and mortality in this population.
Main Methods:
- Retrospective review of severely injured pediatric patients (age ≤ 14 years) with admission rTEG.
- Analysis using Spearman's correlation and regression models to evaluate rTEG against CCT, early transfusion, LSI, and mortality.
Main Results:
- rTEG parameters like activated clotting time, k-time, and α-angle strongly correlated with PTT.
- Maximum amplitude (MA) correlated with platelet count and predicted LSI.
- rTEG values predicted red blood cell and plasma transfusion within 6 hours and mortality.
Conclusions:
- Admission rTEG correlates with CCT in pediatric trauma.
- rTEG effectively predicts early transfusion needs, LSI, and patient outcomes.
- rTEG offers valuable data for goal-directed hemostatic resuscitation in critically injured children.
Purpose:
Admission rapid thrombelastography (rTEG) is a "real-time" clinical tool used to evaluate trauma-induced coagulopathy and direct hemostatic resuscitation. The relationship of rTEG to conventional coagulation tests (CCT) and early lifesaving interventions (LSI) in pediatric trauma is unknown.
Methods:
Severely injured patients (age ≤ 14 years) with an rTEG were retrospectively reviewed (8/1/2009-8/31/2011). Demographic and clinical information was collected. Spearman's correlation and regression models were used to evaluate rTEG with respect to CCT, early transfusion, LSI, and mortality.
Results:
Eighty-six patients were identified. The median age was 8 years, and the median injury severity score (ISS) was 21. Activated clotting time (r=0.68), k-time (r=0.77), and α-angle (r=-0.75) showed strong correlation to PTT, and maximum amplitude (MA) (r=0.46) showed good correlation to platelet count (all p<0.001). When controlling for age, gender, and ISS, regression analysis showed that ACT, r-value, k-time, α-angle, and MA predicted red blood cell and plasma transfusion within 6h. MA (OR 0.82, 95% CI 0.70-0.96; p=0.018) was predictive of LSI. All rTEG values, except for LY30, predicted mortality.
Conclusion:
Admission rTEG correlates with CCT and predicts early transfusion, early LSI, and outcome in pediatric trauma. rTEG provides valuable data for goal-directed hemostatic resuscitation of critically injured children.
