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The impact of acute coagulopathy on mortality in pediatric trauma patients
Aaron Strumwasser1, Allison L Speer, Kenji Inaba
1From the Division of Trauma and Surgical Critical Care (A.S., K.I., L.L., P.T., D.D.), University of Southern California, Los Angeles, CA; Department of Surgery (A.L.S., B.B.), Keck School of Medicine, University of Southern California, Los Angeles, CA; Children's Hospital Los Angeles (J.S.U., H.R.F.), University of Southern California, Los Angeles, CA; Division of Pediatric Surgery (H.R.F.), Los Angeles County-USC Medical Center, Los Angeles, CA; Pathology, University of Southern California Medical Center and Blood Bank (I.S.), Los Angeles, CA; Los Angeles County + USC Health Care Network (I.S.), Los Angeles, CA.
Insights
Pediatric trauma patients rarely develop coagulopathy, but when they do, their mortality risk significantly increases. This contrasts with adult trauma patients who have a higher incidence of coagulopathy.
Area of Science:
- Trauma Care
- Hematology
- Pediatric Critical Care
Background:
- Traumatic coagulopathy (TC) affects 24-38% of adult trauma patients, increasing mortality risk up to sixfold.
- Understanding the incidence and impact of pediatric TC is crucial for improving outcomes.
Purpose of the Study:
- To determine the incidence of pediatric traumatic coagulopathy (TC).
- To assess the impact of pediatric TC on mortality rates.
Main Methods:
- Retrospective review of trauma patients (2004-2009) from a Level I trauma center.
- Coagulopathy defined by INR ≥ 1.5, aPTT > 36 seconds, or platelets < 100,000/mm³.
- Comparison of outcomes between pediatric (<16 years) and adult (≥16 years) patients.
Main Results:
- 7.6% of 20,126 trauma patients were pediatric.
- Pediatric patients had lower incidence of admission coagulopathy (5.8% vs. 8.4%) and were less likely to develop it (8.4% vs. 12.4%).
- Pediatric TC was associated with increased mortality (14.4% vs. 0.5% for non-coagulopathic pediatric patients).
Conclusions:
- Pediatric trauma patients are less prone to developing coagulopathy than adults.
- However, pediatric coagulopathy significantly elevates mortality risk, increasing it stepwise with age.
- Age-related increases in coagulopathy were observed in both TBI and non-TBI cases.
Background:
Traumatic coagulopathy (TC) occurs in 24% to 38% of adults and is associated with up to a six-fold increase in mortality. This study's purpose was to determine the incidence of pediatric TC and its impact on mortality.
Methods:
A retrospective review (2004-2009) of all trauma patients from our Level I trauma center was performed. Coagulopathy was defined as an international normalized ratio of 1.5 or higher or activated partial thromboplastin time of more than 36 seconds or platelets less than 100,000/mm. Clinical outcomes were compared between pediatric (younger than 16 years) and adult patients (≥16 years or older).
Results:
A total of 20,126 patients were identified (7.6% pediatric, 92.4% adult). Mean ± SD age was 8.7 ± 4.8 years for pediatric patients and 37.6 ± 16.7 years for adults. The incidence of admission coagulopathy was lower in children (5.8% vs. 8.4%; p < 0.001). Pediatric patients were less likely to develop coagulopathy (8.4% vs. 12.4%; p < 0.001) and developed coagulopathy later than adults (102.3 ± 123.2 hours vs. 59.2 ± 1,823.9 hours; p < 0.001). Traumatic brain injury (TBI) and non-TBI-related coagulopathy increased in stepwise fashion with age (up to 19.5% in elderly). Adult and pediatric TC was associated with increased mortality (pediatric: 14.4% vs. 0.5%; p = 0.02; adult: 18.3% vs. 1.8%; p < 0.001).
Conclusions:
Pediatric trauma patients are less likely to present with coagulopathy, are less likely to develop coagulopathy during their admission, and tend to develop coagulopathy later than adults. If they develop coagulopathy, however, mortality increases in a stepwise fashion with age and is associated with a two- to four-fold increased risk of death.
Level Of Evidence:
Epidemiologic study, level III.
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