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Injury Severity, Arrival Physiology, Coagulopathy, and Outcomes Among the Youngest Trauma Patients
- Source :
- Journal of Surgical Research. 264:236-241
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Although physiologic differences exist between younger and older children, pediatric trauma analyses are weighted toward older patients. Trauma-induced coagulopathy, determined by rapid thrombelastography (rTEG), is a predictor of outcome in trauma patients, but the significance of rTEG values among very young trauma patients remains unknown. Our objective was to identify the prehospital or physiologic factors, including rTEG values, that were associated with mortality in trauma patients younger than 5 y old.Patients younger than 5 y old that met the highest-level trauma activation criteria at an academic children's hospital from 2010-2016 were included. Data regarding demographics, pre-hospital management, laboratory values, injury severity, and outcome were queried. Univariate and multivariate analyses were performed comparing survivors and non-survivors.A total of 356 patients were included. 60% were male, and the median age was 3 y (IQR 1-4). Overall mortality was 13% (n = 45); brain injury (91%) and hemorrhage (9%) were the causes of death. Compared to survivors, rTEG values in nonsurvivors showed longer activated clotting time and slower speed of clot formation. Clot strength was also decreased in nonsurvivors. On stepwise regression modeling, rTEG values were not significant predictors of mortality. Admission base deficit, arrival temperature, and head injury severity were identified as independent predictors of mortality.While rTEG identified coagulopathy in trauma patients5 y old, it was not an independent predictor of mortality. Our findings suggest that trauma providers should pay close attention to admission base deficit, arrival temperature, and head injury severity when managing the youngest trauma patients.
- Subjects :
- Male
medicine.medical_specialty
Multivariate analysis
Activated clotting time
Hemorrhage
Hypothermia
Risk Assessment
03 medical and health sciences
Injury Severity Score
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Coagulopathy
Humans
Hospital Mortality
Registries
Retrospective Studies
medicine.diagnostic_test
business.industry
Head injury
Infant
Blood Coagulation Disorders
Stepwise regression
medicine.disease
Clot formation
Thrombelastography
Child, Preschool
030220 oncology & carcinogenesis
Wounds and Injuries
Female
030211 gastroenterology & hepatology
Surgery
Clot strength
Acidosis
business
Pediatric trauma
Subjects
Details
- ISSN :
- 00224804
- Volume :
- 264
- Database :
- OpenAIRE
- Journal :
- Journal of Surgical Research
- Accession number :
- edsair.doi.dedup.....bf53a824c56949c73bc3c4b5a8a814b6