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Characterization of organ dysfunction and mortality in pediatric patients with trauma with acute traumatic coagulopathy
  1. Alison Nair1,
  2. Heidi Flori2,
  3. Mitchell Jay Cohen3
  1. 1Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
  2. 2Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
  3. 3Denver Health and Hospital Authority, Denver, Colorado, USA
  1. Correspondence to Dr Alison Nair, Pediatrics, University of California San Francisco, San Francisco, California 94158, USA; Alison.Nair{at}ucsf.edu

Abstract

Background Traumatic injuries are a leading cause of mortality and morbidity in pediatric patients and abnormalities in hemostasis play an important role in these poor outcomes. One such abnormality, acute traumatic coagulopathy (ATC), is a near immediate endogenous response to injury and has recently been described in the pediatric population. This study aims to evaluate the epidemiology of pediatric ATC, specifically its association with organ dysfunction.

Methods All patients with trauma presenting to the University of California, Benioff Children’s Hospital Oakland between 2006 and 2015 with coagulation testing drawn at presentation were included. Patients were excluded if they (1) were >18 years of age, (2) were admitted with a non-mechanical mechanism of injury, (3) were on anticoagulation medications, or (4) had coagulation testing >4 hours after injury. ATC was defined as an international normalized ratio (INR) ≥1.3. The primary outcome was new or progressive multiple organ dysfunction syndrome (MODS) and secondary outcomes included in-hospital mortality and other morbidities.

Results Of the 7382 patients that presented in the 10-year study period, 545 patients met criteria for analysis and 88 patients (16%) presented with ATC. Patients with ATC were more likely to develop MODS than those without ATC (68.4% vs 7.7%, p<0.001) and had higher in-hospital mortality (26.1% vs 0.4%, p<0.001) than those without ATC. Along with arterial hypotension and an Injury Severity Score ≥30, ATC was independent predictor of MODS and in-hospital mortality. An isolated elevated INR was associated with MODS and in-hospital mortality while an isolated elevated partial thromboplastin time was not.

Conclusions Pediatric ATC was associated with organ dysfunction, mortality, and other morbidities. ATC along with arterial hypotension and high injury severity were independent predictors of organ dysfunction and mortality. Pediatric ATC may be biologically distinct from adult ATC and further studies are needed.

Level of evidence IV, epidemiologic.

  • Trauma
  • acute traumatic coagulopathy
  • trauma-induced coagulopathy
  • pediatric
  • organ dysfunctio
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Footnotes

  • Contributors All authors participated in the study design, statistical analysis, interpretation of results, and manuscript preparation. Dr Nair wrote the IRB proposal, participated in the IRB review, performed the data extraction, and conducted the data cleaning.

  • Funding ABN's 4th year fellowship salary was provided through a T32 grant (T32 HD 49303-10) which provided protect research time for the completion of this study. This study was otherwise not supported by any external funding.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Benioff Children's Hospital Oakland, Institutional Review Board, Exempt.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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