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A Pilot Study of Viscoelastic Monitoring in Pediatric Trauma: Outcomes and Lessons Learned
Bola Aladegbami1, Pamela M Choi1, Martin S Keller2
1Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Insights
Viscoelastic monitoring in pediatric trauma patients was linked to increased blood product use and longer hospital stays, but not higher mortality. Further research is needed to optimize its use in managing coagulopathy.
Area of Science:
- Pediatric Trauma Care
- Coagulopathy Management
- Viscoelastic Hemostatic Assays
Background:
- Trauma-induced coagulopathy is a significant concern in pediatric patients.
- Assessing coagulopathy aids in guiding resuscitation strategies.
- The implementation of viscoelastic monitoring aimed to improve outcomes.
Purpose of the Study:
- To examine the characteristics and outcomes of pediatric trauma patients at risk for coagulopathy.
- To evaluate the impact of viscoelastic monitoring (rTEG) compared to conventional testing.
- To assess blood product utilization, ICU stay, ventilation duration, and mortality.
Main Methods:
- Retrospective analysis of 155 pediatric trauma patients (aged <18 years).
- Patients grouped by coagulation assessment: no assessment (NA), conventional coagulation testing (CCT), and CCT with rapid thromboelastography (rTEG).
- Outcomes compared across groups, including blood product use, ICU days, ventilation duration, and mortality.
Main Results:
- rTEG patients were more severely injured, anemic, and received more blood products and crystalloid.
- rTEG use was associated with increased blood product utilization, mechanical ventilation duration, and ICU length of stay.
- Multivariate analysis showed rTEG use was not associated with mortality, but with increased resource utilization.
Conclusions:
- Viscoelastic monitoring was infrequently used but applied to more severely injured pediatric trauma patients.
- While not linked to mortality, rTEG use correlated with increased resource utilization.
- Prospective studies are necessary to establish goal-directed hemostatic resuscitation strategies in pediatric coagulopathy.
Background:
Examine the characteristics and outcomes of pediatric trauma patients at risk for coagulopathy following implementation of viscoelastic monitoring.
Materials And Methods:
Injured children, aged <18 years, from September 7, 2014, to December 21, 2015, at risk for trauma-induced coagulopathy were identified from a single, level-1 American College of Surgeons verified pediatric trauma center. Patients were grouped by coagulation assessment: no assessment (NA), conventional coagulation testing alone (CCT), and conventional coagulation testing with rapid thromboelastography (rTEG). Coagulation assessment was provider preference with all monitoring options continuously available. Groups were compared and outcomes were evaluated including blood product utilization, Intensive Care Unit (ICU) utilization, duration of mechanical ventilation, and mortality.
Results:
A total of 155 patients were identified (NA = 78, CCT = 54, and rTEG = 23). There was no difference in age, gender, race, or mechanism. In practice, rTEG patients were more severely injured, more anemic, and received more blood products and crystalloid (P < 0.001). rTEG patients also had increased mortality with fewer ventilator and ICU-free days. Multivariate logistic regression and covariance analysis indicated that while rTEG use was not associated with mortality, it was associated with increased use of blood products, duration of mechanical ventilation, and ICU length of stay.
Conclusions:
Viscoelastic monitoring was infrequently performed, but utilized in more severely injured patients. Well-designed prospective studies in patients at high risk of coagulopathy are needed to evaluate goal-directed hemostatic resuscitation strategies in children.
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