TY - JOUR
T1 - Diagnostic efficacy of activated partial thromboplastin time waveform and procalcitonin analysis in pediatric meningococcal sepsis
AU - Paize, Fauzia
AU - Carrol, Enitan
AU - Downey, Colin
AU - Parry, Christopher M.
AU - Green, Gerwyn
AU - Diggle, Peter
AU - Newland, Paul
AU - Riordan, F. A I
AU - Thomson, Alistair
AU - Hart, C. A.
AU - Toh, Cheng Hock
PY - 2011/11
Y1 - 2011/11
N2 - Objective: A biphasic activated partial thromboplastin time waveform predicts sepsis and disseminated intravascular coagulation in adults. This has not been previously investigated in children. Our aim is to ascertain whether there are changes in the activated partial thromboplastin time waveform in children with meningococcal disease and to compare its diagnostic use with procalcitonin. Setting: Alder Hey Children's National Health Service Foundation Trust, Liverpool, UK. Patients: Thirty-six children admitted to the hospital for the treatment of suspected meningococcal disease had activated partial thromboplastin time waveform and procalcitonin analysis performed at admission. The light transmittance level at 18 secs was used to quantitate the waveform. Severity of disease was assessed using the Glasgow Meningococcal Septicaemia Prognostic Score, Pediatric Risk of Mortality III score, and the Pediatric Logistic Organ Dysfunction score. Measurements and Main Results: Twenty-four children had proven meningococcal disease, 12 had a presumed viral illness, and 20 control subjects were recruited. Transmittance level at 18 secs was lower in children with meningococcal disease and those with a viral illness (p <.0001) and control subjects (p <.0005). Sensitivity and specificity was 0.91 and 0.96 for transmittance level at 18 secs and 0.92 and 1 for procalcitonin in identifying meningococcal disease. There was a significant difference in procalcitonin between children with meningococcal disease and those with a viral illness and control subjects (p <.0005). A negative correlation was found between transmittance level at 18 secs and length of hospital stay (p <.0001), C-reactive protein (p <.0001), procalcitonin (p <.0001), Glasgow Meningococcal Septicaemia Prognostic Score (p <.01), Pediatric Risk of Mortality III score (p <.0001), and Pediatric Logistic Organ Dysfunction score score (p <.0001). Conclusion: The activated partial thromboplastin time waveform is abnormal in children with meningococcal disease and may be a useful adjunct in the diagnosis and management of sepsis in children.
AB - Objective: A biphasic activated partial thromboplastin time waveform predicts sepsis and disseminated intravascular coagulation in adults. This has not been previously investigated in children. Our aim is to ascertain whether there are changes in the activated partial thromboplastin time waveform in children with meningococcal disease and to compare its diagnostic use with procalcitonin. Setting: Alder Hey Children's National Health Service Foundation Trust, Liverpool, UK. Patients: Thirty-six children admitted to the hospital for the treatment of suspected meningococcal disease had activated partial thromboplastin time waveform and procalcitonin analysis performed at admission. The light transmittance level at 18 secs was used to quantitate the waveform. Severity of disease was assessed using the Glasgow Meningococcal Septicaemia Prognostic Score, Pediatric Risk of Mortality III score, and the Pediatric Logistic Organ Dysfunction score. Measurements and Main Results: Twenty-four children had proven meningococcal disease, 12 had a presumed viral illness, and 20 control subjects were recruited. Transmittance level at 18 secs was lower in children with meningococcal disease and those with a viral illness (p <.0001) and control subjects (p <.0005). Sensitivity and specificity was 0.91 and 0.96 for transmittance level at 18 secs and 0.92 and 1 for procalcitonin in identifying meningococcal disease. There was a significant difference in procalcitonin between children with meningococcal disease and those with a viral illness and control subjects (p <.0005). A negative correlation was found between transmittance level at 18 secs and length of hospital stay (p <.0001), C-reactive protein (p <.0001), procalcitonin (p <.0001), Glasgow Meningococcal Septicaemia Prognostic Score (p <.01), Pediatric Risk of Mortality III score (p <.0001), and Pediatric Logistic Organ Dysfunction score score (p <.0001). Conclusion: The activated partial thromboplastin time waveform is abnormal in children with meningococcal disease and may be a useful adjunct in the diagnosis and management of sepsis in children.
KW - aPTT waveform
KW - children
KW - coagulation
KW - meningococcal disease
KW - sepsis
UR - http://www.scopus.com/inward/record.url?scp=81155152764&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=81155152764&partnerID=8YFLogxK
U2 - 10.1097/PCC.0b013e3182231034
DO - 10.1097/PCC.0b013e3182231034
M3 - Article
C2 - 21666537
AN - SCOPUS:81155152764
SN - 1529-7535
VL - 12
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 6
ER -