Acute Coagulopathy in Children with Multiple Trauma
Acute Coagulopathy in Children with Multiple Trauma
Background Acute coagulopathy associated with trauma has been recognized for decades and is a constituent of the "triad of death" together with hypothermia and acidosis.
Study Objective The aim of this study was to determine to what extent coagulopathy is already established upon emergency department (ED) admission and the association with the severity of injury, impaired outcome, and mortality.
Methods Ninety-one injured children were admitted to the ED in our hospital. Pediatric Trauma Score (PTS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) score were used to estimate injury severity, and organ function was assessed by the Sequential Organ Failure Assessment (SOFA) score.
Results Coagulopathy upon pediatric intensive care unit admission was present in 33 children (39.3%): 21 males and 12 females. PTS ranged from 1 to 12 (mean 8.2) in 51 children without coagulopathy and from −1 to +11 (mean 6.8) in 33 children with coagulopathy (p = 0.087). ISS and GCS ranged from 4 to 57 (mean 28) and from 3 to 11 (mean 7.3), respectively, in the coagulopathy group, whereas in the group without coagulopathy, ISS score ranged from 4 to 41 (mean 20.5; p = 0.08) and GCS from 8 to 15 (mean 12.8; p = 0.01). SOFA ranged from 0 to 10 (mean 3.4) in children without coagulopathy and from 0 to 15 (mean 5.4) in the coagulopathy group (p = 0.002). Among 33 children with coagulopathy, 7 did not survive (21%), all with parenchymal brain damage, whereas all trauma patients without coagulopathy survived (p < 0.001).
Conclusion Acute coagulopathy is present on admission to the ED and is associated with injury severity and significantly higher mortality.
Injury is the principal cause of child death in all developed nations, accounting for almost 40% of deaths in the age group 1–14 years. Traffic accidents, intentional injuries, falls, fires, drowning, and poisoning, taken together with other accidents, kill more than 20,000 1–14-year-olds every year in the Organization for Economic Co-operation and Development (OECD). The death rate in the 1–14-year age group in Greece was in sixth place across the member countries of OECD, with an incidence of 7.0/100,000.
Uncontrolled hemorrhages account for approximately 40% of all trauma deaths within the first 48 h after hospital admission. Bleeding in massively injured patients increases with additional coagulopathy. Coagulopathy associated with trauma has been recognized for decades and is a constituent of the "triad of death," together with hypothermia and acidosis. Only limited data exist on the incidence and extent of acute early coagulopathy in children, showing that early coagulopathy is an independent predictor of mortality in civilian pediatric patients with severe trauma. Early recognition accompanied by adequate management of acute coagulopathy would substantially reduce mortality and improve outcome in severely injured children. The aim of this study was to determine to what extent clinically relevant coagulopathy had already been established upon hospital emergency department (ED) admission and whether its presence was associated with the severity of injury, the increased incidence of organ failure, the early in-hospital mortality (<24 h), and total mortality during hospitalization.
Abstract and Introduction
Abstract
Background Acute coagulopathy associated with trauma has been recognized for decades and is a constituent of the "triad of death" together with hypothermia and acidosis.
Study Objective The aim of this study was to determine to what extent coagulopathy is already established upon emergency department (ED) admission and the association with the severity of injury, impaired outcome, and mortality.
Methods Ninety-one injured children were admitted to the ED in our hospital. Pediatric Trauma Score (PTS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) score were used to estimate injury severity, and organ function was assessed by the Sequential Organ Failure Assessment (SOFA) score.
Results Coagulopathy upon pediatric intensive care unit admission was present in 33 children (39.3%): 21 males and 12 females. PTS ranged from 1 to 12 (mean 8.2) in 51 children without coagulopathy and from −1 to +11 (mean 6.8) in 33 children with coagulopathy (p = 0.087). ISS and GCS ranged from 4 to 57 (mean 28) and from 3 to 11 (mean 7.3), respectively, in the coagulopathy group, whereas in the group without coagulopathy, ISS score ranged from 4 to 41 (mean 20.5; p = 0.08) and GCS from 8 to 15 (mean 12.8; p = 0.01). SOFA ranged from 0 to 10 (mean 3.4) in children without coagulopathy and from 0 to 15 (mean 5.4) in the coagulopathy group (p = 0.002). Among 33 children with coagulopathy, 7 did not survive (21%), all with parenchymal brain damage, whereas all trauma patients without coagulopathy survived (p < 0.001).
Conclusion Acute coagulopathy is present on admission to the ED and is associated with injury severity and significantly higher mortality.
Introduction
Injury is the principal cause of child death in all developed nations, accounting for almost 40% of deaths in the age group 1–14 years. Traffic accidents, intentional injuries, falls, fires, drowning, and poisoning, taken together with other accidents, kill more than 20,000 1–14-year-olds every year in the Organization for Economic Co-operation and Development (OECD). The death rate in the 1–14-year age group in Greece was in sixth place across the member countries of OECD, with an incidence of 7.0/100,000.
Uncontrolled hemorrhages account for approximately 40% of all trauma deaths within the first 48 h after hospital admission. Bleeding in massively injured patients increases with additional coagulopathy. Coagulopathy associated with trauma has been recognized for decades and is a constituent of the "triad of death," together with hypothermia and acidosis. Only limited data exist on the incidence and extent of acute early coagulopathy in children, showing that early coagulopathy is an independent predictor of mortality in civilian pediatric patients with severe trauma. Early recognition accompanied by adequate management of acute coagulopathy would substantially reduce mortality and improve outcome in severely injured children. The aim of this study was to determine to what extent clinically relevant coagulopathy had already been established upon hospital emergency department (ED) admission and whether its presence was associated with the severity of injury, the increased incidence of organ failure, the early in-hospital mortality (<24 h), and total mortality during hospitalization.