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Published on: November 8, 2024
Trauma induced clotting factor depletion in severely injured children: a single center observational study
Manuel Burggraf1, Christina Polan2, Martin Husen2
1Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany. manuel.burggraf@uk-essen.de.
Insights
Pediatric trauma patients experience a depletion of essential clotting factors after severe injury, mirroring adult trauma findings. This suggests potential targets for specific hemostatic therapies in children.
Area of Science:
- Pediatric Traumatology
- Hemostasis and Thrombosis
- Coagulation Medicine
Background:
- Coagulopathy is a significant contributor to mortality in severe trauma patients.
- While impaired clotting factors are documented in adults, their activity in pediatric trauma victims remains under-investigated.
Purpose of the Study:
- To investigate the activity of soluble clotting factors in pediatric trauma patients.
- To compare clotting factor activity between severely and mildly injured pediatric trauma cohorts and a control group.
Main Methods:
- Evaluation of 16 pediatric trauma patients stratified by Injury Severity Score (ISS) into severely (SI) and mildly (MI) injured groups.
- Comparison with a control group (CO) of 10 individuals.
- Testing of routine coagulation parameters and soluble clotting factors (FII, FV, FVII, FIX, FX, FXIII, fibrinogen, FVIII), with nonparametric data analyzed using the Mann-Whitney U test.
Main Results:
- Severely injured (SI) patients exhibited elevated INR compared to controls (p=0.001).
- Significant reductions in FII, FV, and FXIII were observed in SI patients compared to MI patients (p=0.028 for all).
- SI patients showed reduced activity of FII, FV, FXIII, fibrinogen, FVII, FIX, and FX compared to controls (p<0.001 to p=0.001).
Conclusions:
- Pediatric trauma patients experience a depletion of clotting factors following severe injury, consistent with findings in adult trauma patients.
- This depletion highlights potential therapeutic targets for specific hemostatic interventions.
- Further research is required to explore the therapeutic implications of correcting impaired clotting factor activity in pediatric trauma.
Background:
Coagulopathy following severe trauma contributes significantly to mortality. Impaired clotting factors have been observed in adult trauma patients, but in pediatric trauma victims their activity has not yet been investigated.
Methods:
Sixteen pediatric trauma patients were evaluated according to the ISS and assigned to two cohorts. An additional control group (CO; n = 10) was formed. Routine coagulation parameters and the soluble clotting factors (F) were tested. Nonparametric data was analyzed using the Mann-Whitney U test. Results are reported as median and interquartile range.
Results:
The ISS of severely (SI, n = 8) and mildly (MI, n = 8) injured children differed significantly (25 [19-28] vs. 5 [4-6]; p < 0.001). INR was elevated in the SI cohort only when compared to the CO (1.21 [1.04-1.58] vs. 0.96 [0.93-1.00]; p = 0.001). Differences between SI and MI were found for FII (67 [53-90] vs. 82 [76-114] %; p = 0.028), FV (76 [47-88] vs. 92 [82-99] %; p = 0.028), and FXIII (67 [62-87] vs. 90 [77-102] %; p = 0.021). Comparison of the SI with the CO (FII 122 [112-144] %; p < 0.001; FV 123 [100-142] %; p = 0.002; and FXIII 102 [79-115] %; p = 0.006) also revealed a reduction in the activity of these factors. Furthermore, fibrinogen (198 [80-242] vs. 296 [204-324] mg/dl; p = 0.034), FVII (71 [63-97] vs. 114 [100-152] %; p = 0.009), FIX (84 [67-103] vs. 110 [90-114] %; p = 0.043), and FX (70 [61-85] vs. 122 [96-140] %; p = 0.001) were reduced in the SI in comparison with the CO. Finally, FVIII was considerably, yet not significantly, increased in both patient cohorts (235 [91-320] % and 197 [164-238] %, respectively).
Conclusions:
This study proves that children suffer a depletion of clotting factors following severe injury which basically reflects the findings for adult trauma patients. Attempts to correct the impaired clotting factor activity could be based on a specific hemostatic therapy involving administration of coagulation factors. Nevertheless, therapeutic implications need to be investigated in future studies.
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