Acute Coagulopathy in Children with Multiple Trauma
Acute Coagulopathy in Children with Multiple Trauma
In total, 84 children with and without coagulopathy were admitted to the PICU at the University Hospital of Heraklion in Crete after trauma: 57 were boys (67.9%) and 27 were girls (32.1%). The age difference between boys and girls did not reach statistical significance (p = 0.059).
Coagulopathy upon PICU admission was present in 33 of the included 84 children with multiple trauma (39.3%). Twenty-one were males (36.8%) and 12 were girls (44.4%). Their age ranged from 0.2 to 16 years old, and their weight from 5 to 70 kg (Table 2). There was no statistically significant difference between boys and girls as concerns the distribution of the coagulopathy and noncoagulopathy group per gender (p = 0.505) (Table 2). No significant differences between coagulopathy and noncoagulopathy groups per age (p = 0.952) or weight (p = 0.968) were also observed (Table 2).
The incidence of preclinical coagulopathy was also associated with trauma load, as reflected by PTS, ISS, and GCS scores. PTS ranged from 1 to 12 (mean 8.2, SD 3.2) in 51 children without coagulopathy and from −1 to +11 (mean 6.8, SD 3.3) in 33 children with coagulopathy (Table 2). It can be seen that there is a tendency for statistically significant difference between PTS and coagulopathy and noncoagulopathy group (p = 0.087). ISS ranged from 4 to 57 (mean 28, SD 14.8) in the coagulopathy group, whereas children without coagulopathy upon ED admission generally presented with lower ISS score, ranging from 4 to 41 (mean 20.5, SD 10.4) (p = 0.008). Finally, GCS ranged from 3 to 11 (mean 7.3, SD 4.1) in the coagulopathy group and from 8 to 15 (mean 12.8, SD 2.9) in the group without coagulopathy (p = 0.01) (Table 2).
The presence of coagulopathy on PICU admission was associated with impaired outcome and increased mortality. The distribution of SOFA per coagulopathy and noncoagulopathy group is shown in Figure 1. SOFA ranged from 0 to 10 (mean 3.4, SD 2.3) in children without coagulopathy, and from 0 to 15 (mean 5.4, S.D. 4) in the coagulopathy group (p = 0.002) (Table 2). Overall, GCS, ISS, and SOFA scores differed significantly between coagulopathy and noncoagulopathy groups; children with coagulopathy presented lower GCS, higher ISS and SOFA scores, and higher severity and incidence of multiple organ failure.
(Enlarge Image)
Figure 1.
Histogram showing the distribution of patients with and without coagulopathy according to the SOFA severity scoring system.
There were statistically significant differences between noncoagulopathy–coagulopathy groups for INR, PT, aPTT, HGB, and RBC. No significant differences were observed between PLT values (Table 3).
In total, 7 children did not survive (8.3%). 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). Among nonsurvivors, 3 died within 24 h (p < 0.003).
Alive patients presented lower levels of INR, aPTT, and PT, and higher PLT, RBC, and HGB compared to those who died (Table 4).
Results
In total, 84 children with and without coagulopathy were admitted to the PICU at the University Hospital of Heraklion in Crete after trauma: 57 were boys (67.9%) and 27 were girls (32.1%). The age difference between boys and girls did not reach statistical significance (p = 0.059).
Coagulopathy upon PICU admission was present in 33 of the included 84 children with multiple trauma (39.3%). Twenty-one were males (36.8%) and 12 were girls (44.4%). Their age ranged from 0.2 to 16 years old, and their weight from 5 to 70 kg (Table 2). There was no statistically significant difference between boys and girls as concerns the distribution of the coagulopathy and noncoagulopathy group per gender (p = 0.505) (Table 2). No significant differences between coagulopathy and noncoagulopathy groups per age (p = 0.952) or weight (p = 0.968) were also observed (Table 2).
The incidence of preclinical coagulopathy was also associated with trauma load, as reflected by PTS, ISS, and GCS scores. PTS ranged from 1 to 12 (mean 8.2, SD 3.2) in 51 children without coagulopathy and from −1 to +11 (mean 6.8, SD 3.3) in 33 children with coagulopathy (Table 2). It can be seen that there is a tendency for statistically significant difference between PTS and coagulopathy and noncoagulopathy group (p = 0.087). ISS ranged from 4 to 57 (mean 28, SD 14.8) in the coagulopathy group, whereas children without coagulopathy upon ED admission generally presented with lower ISS score, ranging from 4 to 41 (mean 20.5, SD 10.4) (p = 0.008). Finally, GCS ranged from 3 to 11 (mean 7.3, SD 4.1) in the coagulopathy group and from 8 to 15 (mean 12.8, SD 2.9) in the group without coagulopathy (p = 0.01) (Table 2).
The presence of coagulopathy on PICU admission was associated with impaired outcome and increased mortality. The distribution of SOFA per coagulopathy and noncoagulopathy group is shown in Figure 1. SOFA ranged from 0 to 10 (mean 3.4, SD 2.3) in children without coagulopathy, and from 0 to 15 (mean 5.4, S.D. 4) in the coagulopathy group (p = 0.002) (Table 2). Overall, GCS, ISS, and SOFA scores differed significantly between coagulopathy and noncoagulopathy groups; children with coagulopathy presented lower GCS, higher ISS and SOFA scores, and higher severity and incidence of multiple organ failure.
(Enlarge Image)
Figure 1.
Histogram showing the distribution of patients with and without coagulopathy according to the SOFA severity scoring system.
There were statistically significant differences between noncoagulopathy–coagulopathy groups for INR, PT, aPTT, HGB, and RBC. No significant differences were observed between PLT values (Table 3).
In total, 7 children did not survive (8.3%). 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). Among nonsurvivors, 3 died within 24 h (p < 0.003).
Alive patients presented lower levels of INR, aPTT, and PT, and higher PLT, RBC, and HGB compared to those who died (Table 4).
