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Evaluation of acute traumatic coagulopathy in pediatric trauma patients
Yavuz Selim Ayhan1, Ali Korulmaz2, Ali Ertuğ Arslankoylu3
1Private Ruha Academia Hospital, Şanlıurfa-Türkiye.
Insights
Acute traumatic coagulopathy (ATC) affects over half of pediatric trauma patients, increasing mortality risk. International normalized ratio (INR) effectively predicts prognosis in these critical cases.
Area of Science:
- Pediatric Critical Care Medicine
- Trauma Surgery
- Hematology
Background:
- Acute traumatic coagulopathy (ATC) is a significant concern in pediatric trauma.
- Understanding ATC's impact on prognosis is crucial for effective management.
Purpose of the Study:
- To evaluate ATC in pediatric trauma patients.
- To assess the predictive value of coagulopathy findings for prognosis.
Main Methods:
- Retrospective analysis of 282 pediatric trauma patients (1 month-18 years).
- Collected demographic, trauma, clinical, and laboratory data, including scoring systems (GCS, ISS, PTS, PIM2, PELOD).
- Statistically analyzed the relationship between variables and ATC development.
Main Results:
- ATC detected in 66.8% of patients.
- Significant differences in temperature, blood product transfusion, ICU stay, GCS, PTS, ISS, PIM2, PELOD, creatinine, AST, ALT, pH, and HCO3 between ATC and non-ATC groups.
- Higher mortality and transfusion rates observed in patients with ATC.
Conclusions:
- Pediatric trauma patients require close monitoring for coagulopathy.
- International Normalized Ratio (INR) is a reliable independent predictor of prognosis.
- Transfused patients exhibit higher mortality rates.
Background:
This study aimed to evaluate acute traumatic coagulopathy in pediatric trauma patients and to assess the effectiveness of coagulopathy-related findings in predicting prognosis.
Methods:
Patients aged between one month and 18 years who were admitted to our hospital due to trauma between October 2016 and January 2021 were included in the study. Demographic data, type of trauma, presence of acute bleeding, history of blood product transfusion, coagulation and hemogram parameters, as well as Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Pediatric Trauma Score (PTS), Pediatric Index of Mortality 2 (PIM2), and Pediatric Logistic Organ Dysfunction (PELOD) scores were recorded. The relationship of each variable with acute traumatic coagulopathy (ATC) was statistically analyzed.
Results:
A total of 282 patients, including 196 males and 86 females, were included in the study. The most common injury mechanism was motor vehicle accidents (47.5%), and the most frequent type of injury was head trauma (41.8%). Acute traumatic coagulopathy was detected in 141 patients (66.8%). There were statistically significant differences between the groups with and without acute traumatic coagulopathy in terms of admission body temperature, blood product transfusion, length of stay in the pediatric intensive care unit, GCS, PTS, ISS, PIM2, and PELOD scores (p<0.05). Additionally, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), pH, and HCO3 levels in blood gas analyses were significantly different between the groups (p<0.05). However, systolic and diastolic blood pressure, heart rate, urea, platelet count, and lactate levels showed no statistically significant differences between the groups (p>0.05). The mortality rate and frequency of blood product transfusion were found to be statistically significantly higher in the group with acute traumatic coagulopathy (p<0.05) Exitus was observed in 14 (19.4%) transfused patients, while no deaths were recorded among non-transfused patients.
Conclusion:
Trauma patients admitted to pediatric intensive care units should be closely monitored due to the risk of developing coagulopathy. The international normalized ratio (INR) can be used independently to predict the prognosis of these patients. Mortality rates are higher in patients who receive transfusions.
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