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Trauma-induced coagulopathy across age pediatric groups: A retrospective cohort study evaluating testing and
Shyam J Deshpande1,2, Hamilton C Tsang3, Jim Phuong4
1Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA.
Insights
Younger children are not at lower risk for trauma-induced coagulopathy (TIC) than older children. Testing patterns show significant bias, with younger children less likely to be tested for TIC, despite similar risks.
Area of Science:
- Pediatric Trauma Care
- Hemostasis and Thrombosis
- Coagulation Disorders
Background:
- Trauma-induced coagulopathy (TIC) is a serious complication linked to adverse outcomes in pediatric patients.
- Existing research on pediatric TIC primarily focuses on older children, with limited understanding of risks across different developmental hemostasis stages.
- Developmental hemostasis in children may influence their susceptibility to TIC, but this remains under-investigated.
Purpose of the Study:
- To investigate age-related variations in coagulation testing and the incidence of trauma-induced coagulopathy (TIC) in pediatric patients.
- To analyze coagulation testing patterns and TIC frequency across different pediatric age groups.
- To identify potential biases in data collection for pediatric TIC research.
Main Methods:
- Retrospective analysis of coagulation testing patterns and TIC frequency in pediatric patients (2015-2020) at a Level I trauma center.
- Evaluation of testing at presentation and up to 72 hours post-hospitalization, stratified by pediatric age group.
- Application of age-specific reference ranges for TIC diagnosis, controlling for injury severity, with subgroup analyses for severe TBI and direct scene arrivals.
Main Results:
- Children under 1 year showed the lowest rates of TIC testing, irrespective of injury severity.
- Trauma-induced coagulopathy (TIC) was prevalent, affecting 22% at presentation and 35% by 72 hours, with higher incidence in younger age groups (1-9 years) compared to older children in less injured cohorts.
- TIC diagnosis was most frequently met by INR/PT, followed by platelet count, and least by aPTT. TIC presence correlated with increased in-hospital mortality (OR 4.10).
Conclusions:
- Significant sampling bias in clinical data collection for injured children and adolescents was identified.
- Contrary to prior assumptions, younger children (under 10) are not at lower risk of TIC than older children when injury severity is considered.
- Age-specific criteria reveal that TIC is common across pediatric age groups, highlighting the need for tailored diagnostic and management strategies.
Background:
Trauma-induced coagulopathy (TIC) is associated with negative outcomes. Pediatric TIC has been described most often in older children. Children undergo normal developmental hemostasis, but it is unknown how this process impacts the risk of TIC across childhood.
Aims:
To understand variations in coagulation testing and TIC across pediatric age groups.
Methods:
We evaluated testing patterns of coagulation studies at presentation and over the first 72 h of hospitalization by pediatric age group at a large, Level I trauma center, 2015-2020. The frequency of TIC was determined using published, age-specific reference ranges and controlling for injury severity. We performed subgroup analyses of those with isolated severe traumatic brain injury (TBI) and those who presented directly from the scene of injury.
Results:
Data from 2409 pediatric patients were available; 333 patients had isolated severe TBI. Children <1 year were least likely to be tested for TIC at presentation and over the first 72 h, even among the most injured. Fibrinogen testing was uncommon, regardless of injury severity. TIC was common: 22% of patients had TIC at presentation and 35% by 72 h. Greater injury severity was associated with TIC. Children 1-4 and 5-9 years had a higher frequency of TIC at presentation and over 72 h compared to older children in the least injured cohort. We saw no difference in frequency of TIC between age groups in the subset with isolated severe TBI. Using age-specific criteria, patients most often met TIC criteria by INR/PT, followed by platelet count, and least commonly by aPTT. The presence of TIC was associated with in-hospital mortality (OR 4.10, 95% CI 2.06-8.17).
Conclusions:
Significant sampling bias exists in clinical data collection among injured children and adolescents. Contrary to previous reports and using age-specific TIC criteria, younger children are not at lower risk of TIC than older children when controlling for injury severity.
