Characterization of organ dysfunction and mortality in pediatric patients with trauma with acute traumatic coagulopathy

Nair, Alison B; Flori, Heidi R.; Cohen, Mitchell J.

doi:10.1136/tsaco-2019-000382

Cited by 11 publications

(15 citation statements)

References 30 publications

(47 reference statements)

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“…This was primarily driven by a higher prevalence of neurologic and renal dysfunction in the trauma population, and a slightly higher prevalence of respiratory dysfunction. While MODS has been found to be common among pediatric trauma patients with acute traumatic coagulopathy, 16 we did not observe a high prevalence of hematologic or hepatic dysfunction in our cohort relative to general PICU populations. While studies in general PICU populations demonstrated a higher risk for MODS development among younger patients, 10,27 in the trauma population, the risk of MODS was lowest among patients 1 month to 23 months old on multivariable analysis including injury mechanism and body region.…”

Section: Discussioncontrasting

confidence: 83%

Epidemiology and outcomes of multiple organ dysfunction syndrome following pediatric trauma

Killien

Zahlan

Lad

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Existing studies have found a low prevalence of multiple organ dysfunction syndrome (MODS) in pediatric trauma patients, typically applying adult criteria to single-center pediatric cohorts. We used pediatric criteria to determine the prevalence, risk factors, and outcomes of MODS among critically injured children in a national pediatric intensive care unit (PICU) database. METHODS:We conducted a retrospective cohort study of PICU patients 1 month to 17 years with traumatic injury in the Virtual Pediatric Systems, LLC database from 2009 to 2017. We used International Pediatric Sepsis Consensus Conference criteria to identify MODS on Day 1 of PICU admission and estimated the risk of mortality and poor functional outcome (Pediatric Overall/Cerebral Performance Category ≥3 with ≥1 point worsening from baseline) for MODS and for each type of organ dysfunction using generalized linear Poisson regression adjusted for age, comorbidities, injury type and mechanism, and postoperative status. RESULTS: Multiple organ dysfunction syndrome was present on PICU Day 1 in 23.1% of 37,177 trauma patients (n = 8,592), with highest risk among patients with injuries associated with drowning, asphyxiation, and abuse. Pediatric intensive care unit mortality was 20.1% among patients with MODS versus 0.5% among patients without MODS (adjusted relative risk, 32.3; 95% confidence interval, 24.1-43.4). Mortality ranged from 1.5% for one dysfunctional organ system to 69.1% for four or more organ systems and was highest among patients with hematologic dysfunction (43.3%) or renal dysfunction (29.6%). Death or poor functional outcome occurred in 46.7% of MODS patients versus 8.3% of patients without MODS (adjusted relative risk, 4.3; 95% confidence interval 3.4-5.3). CONCLUSION:Multiple organ dysfunction syndrome occurs more frequently following pediatric trauma than previously reported and is associated with high risk of morbidity and mortality. Based on existing literature using identical methodology, both the prevalence and mortality associated with MODS are higher among trauma patients than the general PICU population. Consideration of early organ dysfunction in addition to injury severity may aid prognostication following pediatric trauma.

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Section: Discussioncontrasting

confidence: 83%

Epidemiology and outcomes of multiple organ dysfunction syndrome following pediatric trauma

Killien

Zahlan

Lad

et al. 2022

J Trauma Acute Care Surg

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“…When the trauma is su ciently severe, therefore, DIC develops immediately after trauma without passing through traumainduced coagulopathy stage [15]. Previous studies have shown that trauma-induced coagulopathy was a signi cant risk factor of MODS [27], and was an independent predictor of MODS and mortality in severe trauma [28,29]. These studies indirectly strengthen the present nding of the signi cant performance of DIC in predicting MODS and hospital mortality.…”

Section: Discussionsupporting

confidence: 83%

Disseminated Intravascular Coagulation Immediately after Trauma Predicts a Poor Prognosis in Severely Injured Patients: A Sub-analysis of a Multicenter Prospective Study on Disseminated Intravascular Coagulation in Trauma

Wada

Shiraishi

Gando

et al. 2020

Preprint

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Background: Trauma patients die from massive bleeding due to DIC with a fibrinolytic phenotype in the early phase, which transforms to DIC with a thrombotic phenotype in the late phase of trauma, contributing to the development of MODS and a consequent poor outcome. The aim of this study is to evaluate the effect of a disseminated intravascular coagulation (DIC) diagnosis on the survival probability and predictive performance of DIC scores for massive transfusion, multiple organ dysfunction syndrome (MODS), and hospital death in severely injured trauma patients.Methods: Severely injured adult patients (Injury Severity Score >16) were prospectively evaluated for their DIC scores and molecular markers of coagulation and fibrinolysis immediately after emergency department presentation (0 h) and 3 h after admission. Organ dysfunction was assessed by the sequential organ failure assessment (SOFA) score at 24 h after admission. The performance of DIC scores in predicting massive transfusion, MODS, and hospital death, and the effect of a DIC diagnosis on the survival probability were investigated.Results: The 276 enrolled patients included 121 DIC and 155 non-DIC patients. DIC patients showed larger transfusion volume and higher SOFA scores than non-DIC patients at 24 h after admission. A DIC diagnosis on admission was associated with a lower survival probability (Log Rank p<0.001), higher frequency of massive transfusion and MODS, and higher mortality rate than no such diagnosis. DIC scores at 0 h and 3 h predicted massive transfusion, MODS, and hospital death with significance (all areas under the receiver operating characteristic curves, p<0.001). Markers of thrombin and plasmin generation and fibrinolysis inhibition also showed a good predictive ability for these three items.Conclusions: A DIC diagnosis on admission was associated with a low survival probability. DIC scores obtained immediately after trauma predicted a poor prognosis of severely injured trauma patients.Trial registration: UMIN-CTR, UMIN000019588. Registered on 16 November 2015.

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“…When the trauma is sufficiently severe, therefore, DIC develops immediately after trauma without passing through the trauma-induced coagulopathy stage 15 . Previous studies have shown that trauma-induced coagulopathy was a significant risk factor of MODS 34 and an independent predictor of MODS and mortality in cases of severe trauma 35 , 36 . These studies indirectly strengthen the present finding of the significant performance of DIC in predicting MODS and hospital mortality.…”

Section: Discussionmentioning

confidence: 93%

Disseminated intravascular coagulation immediately after trauma predicts a poor prognosis in severely injured patients

Wada

Shiraishi

Gando

et al. 2021

Sci Rep

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Trauma patients die from massive bleeding due to disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype in the early phase, which transforms to DIC with a thrombotic phenotype in the late phase of trauma, contributing to the development of multiple organ dysfunction syndrome (MODS) and a consequently poor outcome. This is a sub-analysis of a multicenter prospective descriptive cross-sectional study on DIC to evaluate the effect of a DIC diagnosis on the survival probability and predictive performance of DIC scores for massive transfusion, MODS, and hospital death in severely injured trauma patients. A DIC diagnosis on admission was associated with a lower survival probability (Log Rank P < 0.001), higher frequency of massive transfusion and MODS and a higher mortality rate than no such diagnosis. The DIC scores at 0 and 3 h significantly predicted massive transfusion, MODS, and hospital death. Markers of thrombin and plasmin generation and fibrinolysis inhibition also showed a good predictive ability for these three items. In conclusion, a DIC diagnosis on admission was associated with a low survival probability. DIC scores obtained immediately after trauma predicted a poor prognosis of severely injured trauma patients.

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Characterization of organ dysfunction and mortality in pediatric patients with trauma with acute traumatic coagulopathy

Cited by 11 publications

References 30 publications

Epidemiology and outcomes of multiple organ dysfunction syndrome following pediatric trauma

Epidemiology and outcomes of multiple organ dysfunction syndrome following pediatric trauma

Disseminated Intravascular Coagulation Immediately after Trauma Predicts a Poor Prognosis in Severely Injured Patients: A Sub-analysis of a Multicenter Prospective Study on Disseminated Intravascular Coagulation in Trauma

Disseminated intravascular coagulation immediately after trauma predicts a poor prognosis in severely injured patients

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