Acute traumatic coagulopathy in a critically injured pediatric population
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Le résumé fourni par la source
BACKGROUND: While our understanding of acute traumatic coagulopathy (ATC) in adults is advancing, the pediatric literature on ATC is limited. Children have a unique injury profile and physiologic response to trauma; however, the impact of this phenomenon on ATC has not been fully elucidated. METHODS: We performed a retrospective review of our trauma registry from 2005 to 2014. Level 1 trauma patients age 0 year to 17 years requiring admission to the intensive care unit were included. Variables included admission vital signs and laboratory studies, product transfusion, injuries, and mortality. Youden index was used to determine optimum cutoff point for admission international normalized ratio (INR) as a predictor of mortality. Logistic regression modeling was used to determine independent predictors of mortality adjusting for hypotension, hypothermia, acidosis, injury severity, hemorrhage, and head injury. χ tests were performed evaluating for association between mortality and 24-hour INR as well as between transfusion and INR correction. RESULTS: A total of 776 patients were analyzed: 29.2% (n = 227) had an admission INR of 1.3 or greater, and 13.3% (n = 103) had an admission INR of 1.5 or greater. Youden index demonstrated optimum cutoff at INR of 1.3 or greater to distinguish survivors and nonsurvivors. Overall mortality rate was 11.1% (n = 86). Elevated INR was independently associated with mortality (odds ratio, 3.77; p < 0.001) after controlling for other predictors in regression modeling. Death was also associated with elevated INR at 24 hours and worsening INR trend over time. Patients who received plasma were equally likely to normalize their INR compared with those who were not transfused (p = nonsignificant). Findings were consistent across age groups. CONCLUSION: INR likely serves as a marker of systemic dysregulation rather than a treatment target in ATC. Elevated admission INR, elevated INR at 24 hours, and overall trend in INR strongly predict mortality in a diverse pediatric trauma population; however, product transfusion did not influence the INR trend or clinical outcome. Further research is warranted to evaluate potential upstream mediators of ATC and targets for intervention in pediatric trauma patients. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Acute traumatic coagulopathy in a critically injured pediatric population
- Date Crossref
- 01/07/2016
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Center for Strategic and International Studies pays non établi dans la noticeInstitution
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University of Pittsburgh Department of Surgery pays non établi dans la noticeUniversité ou école supérieure
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San Francisco Estuary Institute pays non établi dans la noticeOrganisation à but non lucratif
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Children's Hospital of Pittsburgh pays non établi dans la noticeÉtablissement de santé
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University of Pittsburgh Medical Center pays non établi dans la noticeÉtablissement de santé
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Johns Hopkins Hospital Division of Pediatric Surgery (I.N.) pays non établi dans la noticeÉtablissement de santé
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Submitted: December 2 pays non établi dans la noticeInstitution
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This study was presented at the 29th annual meeting of the Eastern Association for the Surgery of Trauma pays non établi dans la noticeOrganisation à but non lucratif
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email: [email protected] pays non établi dans la noticeInstitution
Center for Strategic and International Studies, Department of Surgery — University of Pittsburgh et San Francisco Estuary Institute, avec 6 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.