Coagulation testing in pediatric blunt trauma patients

Abstract

Hospitalized pediatric blunt trauma patients frequently have minor elevations in ED coagulation studies. Marked elevations occur infrequently and are independently associated with a GCS < or =13, low systolic blood pressure, open/multiple bony fractures, and major tissue wounds.

The use of repeated head computed tomography in blunt pediatric head trauma: Factors predicting new and worsening brain injury*

“…We recorded only the initial and the worst value of each variable before the second head CT. For surgical patients we also documented the last GCS and ICP values before the second CT and the timing of surgery. For analysis, we selected abnormal thresholds for ICP (Ͼ20 mm Hg) (15), coagulation (prothrombin international normalized ratio Ն1.2, PTT Ն33 secs) (16), hematocrit (Ͻ30%) (17), platelets (Ͻ100,000/L) (18), PaCO 2 (Ͻ35 mm Hg) (19), oxygen saturation (Ͻ90%) (20), systolic blood pressure (Ͻ70 mm Hg ϩ [2ϫ age in years]) (20), and temperature (Ͻ35°C) (21), based on the literature. These thresholds were used to test the predictive value of laboratory and clinical findings.…”

Implementation of a pediatric trauma massive transfusion protocol: one institution's experience

“…Coagulopathy in pediatric trauma patients is more common that previously realized, especially among patients ill enough to require transfusion support. Furthermore, this coagulopathy is associated with morbidity and mortality 12‐17 . These associations have been observed in pediatric trauma patients suffering from blunt or penetrating injuries, with or without head involvement.…”

“…Furthermore, this coagulopathy is associated with morbidity and mortality. [12][13][14][15][16][17] These associations have been observed in pediatric trauma patients suffering from blunt or penetrating injuries, with or without head involvement. In fact, it has recently been proposed that a score including coagulation data ("BIG" score: base deficit + [2.5 ¥ international normalized ratio] + [15 -Glasgow Coma Scale score]) may more accurately predict mortality in pediatric trauma patients than scoring systems currently in use.…”

Tranexamic acid in pediatric trauma: why not?

“…Coagulopathy in both pediatric and adult head trauma is well described, and its published incidence ranges from 15% to 87% [32-34]. In pediatric blunt trauma, coagulopathy was reported in 28% of patients by Holmes and colleagues [35], with significant coagulopathy occurring in 6% of children and associated with a Glasgow Coma Scale score ≤13, low systolic blood pressure, open/multiple fractures, and major tissue wounds. Hendrickson and colleagues [36] described coagulopathy in pediatric trauma patients specifically requiring transfusion support using a combined retrospective review and prospective analysis of 102 children (mean age of 6 years, injury severity score of 22 and Glasgow Coma Scale score of 7) presenting to an emergency department over a 4-year period.…”