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Published on: November 8, 2024
Thrombelastography and transfusion patterns in severely injured pediatric trauma patients with blunt solid organ
Jenny Stevens1, Kaci Pickett, Hunter Moore
1From the Division of Pediatric Surgery (J.S., M.L.R., R.P., S.M., D.B.), Children's Hospital Colorado, Division of Pediatric Surgery, Department of Surgery (J.S., M.L.R., R.P., S.M., D.B.), and Center for Research in Outcomes for Children's Surgery (K.P.), Center for Children's Surgery, University of Colorado School of Medicine, Aurora; and Department of Surgery (H.M., D.B.), Denver Health Medical Center, Denver, Colorado.
Insights
Thrombelastography (TEG) guided resuscitation with platelets and cryoprecipitate in pediatric trauma patients with blunt solid organ injuries significantly reduced hospital stay and mortality. This approach effectively manages coagulopathy in critically injured children.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Coagulation Medicine
Background:
- Thrombelastography (TEG) is a valuable tool for diagnosing coagulopathy and guiding blood product use in trauma resuscitation.
- Pediatric trauma patients with blunt solid organ injuries (BSOIs) often present with coagulopathy.
Purpose of the Study:
- To evaluate the correlation between TEG-guided blood product administration and clinical outcomes in severely injured pediatric trauma patients with BSOIs.
- To assess the effectiveness of TEG in directing resuscitation strategies.
Main Methods:
- Inclusion of pediatric patients (≤18 years) with severe BSOIs requiring highest-level trauma activation.
- Evaluation of TEG parameters (R time, α angle, maximum amplitude, clot lysis) to guide blood product administration.
- Statistical analysis using tetrachoric correlations and regression modeling to link TEG-directed resuscitation with outcomes.
Main Results:
- Coagulopathy was present in a significant proportion of pediatric trauma patients with BSOIs.
- TEG-directed resuscitation with platelets and cryoprecipitate was implemented in the majority of cases.
- Resuscitation guided by TEG for platelets (OR 0.56) and cryoprecipitate (OR 0.09) was associated with reduced hospital length of stay and mortality, respectively.
Conclusions:
- Severely injured pediatric trauma patients with BSOIs frequently exhibit coagulopathy.
- TEG-guided resuscitation, particularly with platelets and cryoprecipitate, is associated with improved clinical outcomes, including decreased length of stay and mortality.
Background:
Thrombelastography (TEG) has emerged as a useful tool to diagnose coagulopathy and guide blood product usage during trauma resuscitations. This study sought to evaluate the correlation between TEG-directed blood product administration in severely injured pediatric trauma patients with blunt solid organ injuries (BSOIs).
Methods:
Patients (≤18 years) with severe BSOIs who presented as highest-level trauma activations at two pediatric trauma centers were included. Thrombelastography results were evaluated to determine indications for blood product administration and rates of TEG-directed resuscitation. Tetrachoric correlations and regression modeling were used to correlate TEG-directed resuscitation with clinical outcomes.
Results:
Of 64 patients who met the inclusion criteria, 32.8% (21) had elevated R times and 23.4% (15) had shortened α angles. Maximum amplitude was shortened in 29.7% (19), and percent clot lysis 30 minutes after maximum amplitude that is >3% was seen in 17.0% (9). Thrombelastography-directed resuscitation of fresh frozen plasma was followed 54.7% of the time compared with 67.2% and 81.2% for platelets and cryoprecipitate, respectively. Thrombelastography-directed resuscitation with platelets (odds ratio, 0.56; 95% confidence interval, 0.33-0.93; p = 0.03) and/or cryoprecipitate (odds ratio, 0.09; 95% confidence interval, 0.01-0.42, p = 0.003) were associated with decreased hospital length of stay and mortality, respectively.
Conclusion:
Severely injured pediatric trauma patients with BSOIs were often coagulopathic upon presentation to the emergency department. Thrombelastography-directed resuscitation with platelets and/or cryoprecipitate was followed for the majority of patients and was associated with improved outcomes.
Level Of Evidence:
Therapeutic/Care Management, level III.
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