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Rotational thromboelastometry predicts transfusion and disability in pediatric trauma.
Aaron J Cunningham1, Mary Condron, Martin A Schreiber
1From the Department of Surgery (A.J.C.), Oregon Health and Sciences University; Trauma and Acute Care Surgical Services (M.C.), St. Charles Health System, Bend; Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery (M.C., M.A.S.), Oregon Health and Sciences University; Division of Pediatric Surgery (K.A., N.A.H., M.A.J.), Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, OR; Trauma Services (K.D., W.B.L.), Legacy Emanuel Medical Center; Department of Anesthesiology (B.G.M.), Randall Children's Hospital at Legacy Emanuel; and Division of Pediatric Surgery (M.A.J.), Randall Children's Hospital at Legacy Emanuel, Portland, Oregon.
Rotational thromboelastometry (ROTEM) can predict outcomes in injured children. Specific ROTEM thresholds guide blood product transfusions, improving outcomes for pediatric trauma patients.
Area of Science:
- Pediatric Trauma Care
- Hemostasis and Thrombosis
- Critical Care Medicine
Background:
- Trauma-induced coagulopathy (TIC) impacts adult outcomes, but its role in pediatric trauma is unclear.
- Rotational thromboelastometry (ROTEM) is a viscoelastic hemostatic assay used to assess coagulation.
- Understanding TIC in children is crucial for timely and appropriate management.
Purpose of the Study:
- Define ROTEM thresholds for product-specific transfusion in pediatric trauma.
- Evaluate the prognostic value of ROTEM for clinical outcomes in injured children.
- Establish evidence-based guidelines for managing coagulopathy in pediatric trauma patients.
Main Methods:
- Retrospective analysis of severely injured children (<18 years) at a Level I trauma center.
- Utilized receiver operating characteristic (ROC) curves and Youden indexes to determine transfusion thresholds.
- Correlated ROTEM parameters with outcomes of mortality or disability at discharge.
Main Results:
- Ninety pediatric trauma patients were reviewed.
- Specific ROTEM parameters associated with transfusion needs: EXTEM clotting time (CT) >84.5 sec, EXTEM amplitude at 10 minutes (A10) <43.5 mm, and EXTEM maximal clot firmness (MCF) <64.5 mm.
- Prolonged EXTEM CT (>68.5 seconds) predicted mortality or disability.
Conclusions:
- Coagulation abnormalities identified by ROTEM are linked to adverse outcomes in children.
- Proposed ROTEM-guided transfusion thresholds: plasma for EXTEM CT >84.5s, fibrinogen for EXTEM A10 <43.5mm, platelets for EXTEM MCF <64.5mm.
- ROTEM can guide transfusion strategies and improve prognostication in pediatric trauma.
