Acute traumatic coagulopathy in a critically-injured pediatric population: Definition, trend over time and outcomes

Christine M. Leeper, Matthew Kutcher, Isam Nasr, Christine McKenna, Timothy Billiar, Matthew D. Neal, Jason Sperry, Barbara A. Gaines

Research output: Contribution to journalArticle

Abstract

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 2005-2014. Level 1 trauma patients age 0-17 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 utilized to determine optimum cutoff point for admission INR as predictor of mortality. Logistic regression modeling was utilized to determine independent predictors of mortality adjusting for hypotension, hypothermia, acidosis, injury severity, hemorrhage and head injury. Chi-square tests were performed evaluating for association between mortality and 24-hour INR, and between transfusion and INR correction. RESULTS: 776 patients were analyzed: 29.2% (n=227) had admission INR≥1.3 and 13.3% (n=103) with admission INR≥1.5. Youden index demonstrated optimum cutoff of INR≥1.3 to distinguish survivors and non-survivors. Overall mortality rate was 11.1% (n=86). Elevated INR was independently associated with mortality (OR 3.77, p

Original languageEnglish (US)
JournalThe journal of trauma and acute care surgery
DOIs
Publication statusAccepted/In press - Feb 16 2016

    Fingerprint

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this