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Updated: Apr 24, 2026
Author Spotlight: Deciphering Coagulation Disorders in Traumatic Brain Injury Patients
Published on: August 4, 2023
Acute coagulopathy in children with multiple trauma: a retrospective study
George Sakellaris1, Evangelos Blevrakis1, Ioannis Petrakis2
1Department of Pediatric Surgery, University Hospital of Heraklion, Greece.
Insights
Acute coagulopathy is common in injured children upon emergency department admission and is linked to more severe injuries. This condition significantly increases the risk of mortality in pediatric trauma patients.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Hematology
Background:
- Acute coagulopathy is a known component of the "triad of death" in trauma patients, alongside hypothermia and acidosis.
- Understanding coagulopathy's prevalence and impact in pediatric trauma is crucial for improving outcomes.
Purpose of the Study:
- To assess the extent of coagulopathy upon emergency department (ED) admission in pediatric trauma patients.
- To investigate the association between coagulopathy, injury severity, and patient outcomes, including mortality.
Main Methods:
- A cohort of 91 injured children admitted to the ED was studied.
- Injury severity was evaluated using the Pediatric Trauma Score (PTS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS).
- Organ function was assessed using the Sequential Organ Failure Assessment (SOFA) score.
Main Results:
- Coagulopathy was present in 39.3% of pediatric patients upon admission.
- Patients with coagulopathy exhibited higher ISS and SOFA scores, indicating more severe injuries and organ dysfunction.
- A significant association was found between coagulopathy and increased mortality (21% vs. 0% in non-coagulopathic patients).
Conclusions:
- Acute coagulopathy is established at the time of ED admission in pediatric trauma patients.
- The presence of coagulopathy correlates with greater injury severity and a substantially higher risk of death.
Background:
Acute coagulopathy associated with trauma has been recognized for decades and is a constituent of the "triad of death" together with hypothermia and acidosis.
Study Objective:
The aim of this study was to determine to what extent coagulopathy is already established upon emergency department (ED) admission and the association with the severity of injury, impaired outcome, and mortality.
Methods:
Ninety-one injured children were admitted to the ED in our hospital. Pediatric Trauma Score (PTS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) score were used to estimate injury severity, and organ function was assessed by the Sequential Organ Failure Assessment (SOFA) score.
Results:
Coagulopathy upon pediatric intensive care unit admission was present in 33 children (39.3%): 21 males and 12 females. PTS ranged from 1 to 12 (mean 8.2) in 51 children without coagulopathy and from -1 to +11 (mean 6.8) in 33 children with coagulopathy (p = 0.087). ISS and GCS ranged from 4 to 57 (mean 28) and from 3 to 11 (mean 7.3), respectively, in the coagulopathy group, whereas in the group without coagulopathy, ISS score ranged from 4 to 41 (mean 20.5; p = 0.08) and GCS from 8 to 15 (mean 12.8; p = 0.01). SOFA ranged from 0 to 10 (mean 3.4) in children without coagulopathy and from 0 to 15 (mean 5.4) in the coagulopathy group (p = 0.002). Among 33 children with coagulopathy, 7 did not survive (21%), all with parenchymal brain damage, whereas all trauma patients without coagulopathy survived (p < 0.001).
Conclusion:
Acute coagulopathy is present on admission to the ED and is associated with injury severity and significantly higher mortality.
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