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Clinical and Laboratory Markers to Predict the Need for Intubation in Pediatric Trauma
Mehmet Akif Dündar1, Sedanur Tekin Can2, Başak Nur Akyıldız1
1Division of Pediatric Intensive Care, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Türkiye.
Insights
Female sex, elevated blood glucose, and decreased platelet count predict the need for emergency tracheal intubation in pediatric trauma patients. These findings aid early airway management decisions in critical care.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Critical Care
- Airway Management
Background:
- Emergency tracheal intubation is vital for managing pediatric trauma patients.
- Identifying predictive markers for airway intervention is crucial for this vulnerable population.
Purpose of the Study:
- To determine clinical and laboratory markers that predict the need for tracheal intubation in pediatric trauma patients.
- To identify key indicators for timely airway intervention in pediatric critical care.
Main Methods:
- Observational cohort analysis of 96 pediatric trauma patients (<18 years) admitted to a Pediatric Intensive Care Unit (PICU).
- Analysis included demographic data, trauma characteristics, clinical parameters, and laboratory markers.
- Logistic regression and ROC analysis were used to identify intubation predictors.
Main Results:
- 45.8% of patients required intubation. Female sex, motor vehicle accidents, drowning, and multisystem trauma were associated with higher intubation rates.
- Elevated blood glucose, AST, ALT, creatinine, procalcitonin, INR, and lactate levels were observed in intubated patients.
- Independent predictors identified were female sex, elevated blood glucose, decreased platelet count, and blood transfusion requirement. Intubated patients had longer PICU and hospital stays.
Conclusions:
- Female sex, specific trauma etiologies (MVAs, drowning, multisystem trauma), and laboratory markers (elevated glucose, decreased platelets) predict intubation need.
- Blood transfusion requirement is also an independent predictor of intubation.
- These markers assist in guiding early airway management decisions in pediatric trauma care.
Objective:
Emergency tracheal intubation is a critical component of acute management in children with traumatic injuries. This study aimed to determine which clinical and laboratory markers are most predictive of the need for airway intervention in this vulnerable population.
Materials And Methods:
This observational cohort analysis included 96 pediatric trauma patients under 18 years of age admitted to a university hospital Pediatric Intensive Care Unit (PICU). Demographic data, trauma characteristics, clinical parameters, and laboratory markers were analyzed. Statistical analyses included logistic regression and receiver operating characteristic (ROC) analysis to identify predictors of intubation.
Results:
Among the 96 pediatric trauma patients, 45.8% required intubation. Female patients had significantly higher intubation rates (45.5%) compared to males (36.9%) (p=0.011). Trauma etiology differed significantly, with traffic accidents being more common among intubated patients, while falls from height were more frequent in non-intubated patients (p=0.007). Patients with multiple system injuries had an increased likelihood of intubation (p=0.004). Intubated patients had markedly higher blood glucose level, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, procalcitonin, international normalized ratio (INR), and lactate levels, while platelet counts were significantly decreased (p<0.001, p=0.036, p=0.039, p=0.026, p=0.002, p=0.007, p=0.003, and p=0.031, respectively). Logistic regression identified female sex, elevated blood glucose, decreased platelet count, and blood transfusion requirement as independent predictors. Intubated patients had significantly longer PICU stays (7.0 vs. 3.0 days, p<0.001) and overall hospital stays (14.5 vs. 7.0 days, p<0.001).
Conclusion:
Female sex, motor vehicle accidents, drowning, and multisystem trauma were significantly associated with an increased risk of intubation. Key laboratory predictors included elevated blood glucose levels, decreased platelet count, and the need for blood transfusion. These markers can help guide early airway management decisions in pediatric trauma care.
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