Related Experiment Video
Updated: Dec 2, 2025
Experimental Strategies to Bridge Large Tissue Gaps in the Injured Spinal Cord after Acute and Chronic Lesion
Published on: April 5, 2016
Prothrombin Time ratio can predict mortality in severe pediatric trauma: Study in a French trauma center level 1
Audrey Hochart1, Romain Momal2, Delphine Garrigue-Huet3
1CHU Lille, Institut d'Hématologie et de Transfusion, F-59000 Lille, France.
Insights
Early coagulopathy in pediatric trauma, measured by Prothrombin Time ratio (PTr) ≥1.24, effectively predicts mortality and identifies severe injuries. This quick test aids in trauma triage for children.
Area of Science:
- Pediatric Trauma Care
- Coagulopathy Diagnostics
- Injury Severity Assessment
Background:
- Pediatric injury is a leading cause of death, yet data on early coagulopathy's impact is limited.
- Understanding coagulopathy in pediatric trauma is crucial for improving outcomes.
Purpose of the Study:
- Determine the optimal Prothrombin Time ratio (PTr) cut-off for predicting mortality in pediatric trauma patients.
- Evaluate the diagnostic characteristics of PTr for mortality prediction.
Main Methods:
- Retrospective analysis of pediatric patients (<16 years) with Injury Severity Score (ISS) ≥9.
- Inclusion of 272 children over a 4-year period.
Main Results:
- Optimal PTr cut-off for mortality prediction was 1.24 (sensitivity 84%, specificity 82%).
- PTr ≥1.24 correlated with higher mortality, need for transfusion, severe injuries, and intensive care unit admission.
- Early mortality (24h) and need for massive transfusion were significantly predicted by PTr.
Conclusions:
- Prothrombin Time ratio (PTr) ≥1.24 serves as a valuable severity marker in pediatric trauma.
- PTr is a sensitive, specific, rapid, and user-friendly tool for pediatric trauma triage.
Background:
Injury results in more deaths in children than all other causes combined, but there is little data regarding the association of early coagulopathy on outcomes in pediatric patients with traumatic injuries. The aim of this study was to determine the optimal cut-off value for the Prothrombin Time ratio (PTr) and to show the diagnostic characteristics of the PTr to predict mortality.
Methods:
We retrospectively included during 4 years all patients less than 16 years old referred to our trauma center for traumatic injury with ISS ≥9.
Results:
A total of 272 children were included. Mean age was 9.4 ± 4.8 years and median ISS was 17 [interquartile range, 12 to 26]. Day 28 mortality was 6.7%. The optimal cut-off value in our population for predicting day 28 mortality was 1.24. Using this value, the sensitivity of PTr was 84%, specificity was 82%, positive likelihood ratio was 4.7, and negative likelihood ratio was 0.19. Early mortality (i.e., mortality at 24 h) was also well-predicted (1.0% versus 16.4%, p < .0001), as the need for massive transfuion. Similarly, patients with PTr ≥1.24 at admission presented with a higher rate of severe thoracic and abdominal trauma, higher ISS, higher likelihood of admission to an intensive care unit, longer hospitalization, and higher rate of significant procedure (e.g., surgery or embolization).
Conclusions:
Trauma-induced coagulopathy defined only by a PTr ≥1.24 could be used as a severity predictive marker and as a sensitive, specific, quick, and easy to use tool for admission triage of pediatric patients.
