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Paediatric trauma and hypocalcaemia: a systematic review
Mary-Beth Toner1, Michael Coffey2, Ulugbek Nurmatov3
1Royal Belfast Hospital for Sick Children, Belfast, UK mtoner13@qub.ac.uk.
Insights
Hypocalcaemia (low calcium) in paediatric trauma is less common than in adults. Limited studies suggest it may be linked to worse outcomes, but more research is needed to confirm these findings in children.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Critical Care
Background:
- Trauma is a major cause of child mortality and morbidity globally.
- Hypocalcaemia is linked to adverse outcomes in adult trauma but is understudied in children.
- This review examines hypocalcaemia in paediatric trauma patients.
Purpose of the Study:
- To systematically review the prevalence of hypocalcaemia in paediatric trauma.
- To investigate the clinical implications and associations of hypocalcaemia in this population.
- To identify gaps in current research for future studies.
Main Methods:
- Comprehensive literature search of four databases and grey literature.
- Inclusion of original studies on paediatric trauma with pre-transfusion ionized calcium measurements.
- Exclusion of case reports, series, reviews, and non-English papers; quality assessment using Newcastle-Ottawa Scale.
Main Results:
- Two retrospective cohort studies involving 568 patients met inclusion criteria.
- Hypocalcaemia incidence ranged from 5.3% to 19.8%.
- Observed trends towards increased mortality, transfusion needs, and hospital stay, but without consistent statistical significance.
Conclusions:
- Hypocalcaemia incidence in paediatric trauma is lower than in adults.
- Limited evidence suggests potential adverse outcome associations, though not consistently significant.
- Further prospective research with larger sample sizes is crucial for definitive understanding and improved patient management.
Background:
Trauma is a leading cause of mortality and morbidity in children worldwide. While adult studies have demonstrated hypocalcaemia's association with adverse outcomes, its impact on paediatric trauma patients remains understudied. This systematic review aims to investigate current evidence into the prevalence, clinical implications and associations of hypocalcaemia in paediatric trauma.
Methods:
A comprehensive literature search was conducted searching four databases, grey literature and additional sources for original studies looking at outcomes for paediatric trauma patients with ionised calcium measurements before blood product administration. Exclusion criteria comprised studies which included patients with blood product administration prior to calcium measurement, case reports, case series, reviews and papers not available in English. The review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42023432473. Data extraction was performed on included papers and quality assessment performed using Newcastle-Ottawa Scale.
Results:
Of 779 initial studies, two studies met inclusion criteria for detailed analysis. Both retrospective cohort studies originated in Israel and collectively included 568 patients. Hypocalcaemia incidence ranged from 5.3% to 19.8%. Although trends towards increased mortality, blood transfusion requirements and prolonged hospital stays were observed in patients with hypocalcaemia, statistical significance was not consistently achieved.
Conclusion:
Hypocalcaemia in paediatric trauma appears reduced in incidence compared with adult populations. Limited available studies suggest potential associations with adverse outcomes, although most were not statistically significant. Studies had small patient numbers, necessitating further prospective research to facilitate a clearer understanding. Insights from such studies can guide patient management and improve outcomes in this vulnerable population.
Prospero Registration Number:
CRD42023432473.
