The impact of acute coagulopathy on mortality in pediatric trauma patients

Aaron Strumwasser, Allison L. Speer, Kenji Inaba, Bernardino C. Branco, Jeffrey S. Upperman, Henri Ford, Lydia Lam, Peep Talving, Ira Shulman, Demetrios Demetriades

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Traumatic coagulopathy (TC) occurs in 24% to 38% of adults and is associated with up to a six-fold increase in mortality. This study's purpose was to determine the incidence of pediatric TC and its impact on mortality. METHODS: Aretrospective review(2004-2009) of all trauma patients from our Level I trauma centerwas performed. Coagulopathywas defined as an international normalized ratio of 1. 5 or higher or activated partial thromboplastin time of more than 36 seconds or platelets less than 100, 000/mm3. Clinical outcomes were compared between pediatric (younger than 16 years) and adult patients (≥16 years or older). RESULTS: A total of 20, 126 patients were identified (7.6% pediatric, 92.4% adult). Mean ± SD age was 8.7 ± 4. 8 years for pediatric patients and 37.6 ± 16.7 years for adults. The incidence of admission coagulopathy was lower in children (5.8% vs. 8. 4%; p < 0.001). Pediatric patients were less likely to develop coagulopathy (8.4%vs. 12. 4%; p < 0.001) and developed coagulopathy later than adults (102.3 ± 123.2 hours vs. 59.2 ± 1, 823. 9 hours; p < 0.001). Traumatic brain injury (TBI) and non-TBI-related coagulopathy increased in stepwise fashion with age (up to 19.5%in elderly). Adult and pediatric TC was associated with increased mortality (pediatric: 14.4% vs. 0. 5%; p = 0.02; adult: 18. 3% vs. 1. 8%; p < 0.001). CONCLUSIONS: Pediatric trauma patients are less likely to present with coagulopathy, are less likely to develop coagulopathy during their admission, and tend to develop coagulopathy later than adults. If they develop coagulopathy, however, mortality increases in a stepwise fashion with age and is associated with a two- to four-fold increased risk of death.

Original languageEnglish (US)
Pages (from-to)312-318
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume81
Issue number2
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Fingerprint

Pediatrics
Mortality
Wounds and Injuries
International Normalized Ratio
Partial Thromboplastin Time
Incidence
Brain Injuries
Blood Platelets

Keywords

  • Children
  • Coagulopathy
  • Injury
  • Mortality
  • Pediatric
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Strumwasser, A., Speer, A. L., Inaba, K., Branco, B. C., Upperman, J. S., Ford, H., ... Demetriades, D. (2016). The impact of acute coagulopathy on mortality in pediatric trauma patients. Journal of Trauma and Acute Care Surgery, 81(2), 312-318. https://doi.org/10.1097/TA.0000000000001060

The impact of acute coagulopathy on mortality in pediatric trauma patients. / Strumwasser, Aaron; Speer, Allison L.; Inaba, Kenji; Branco, Bernardino C.; Upperman, Jeffrey S.; Ford, Henri; Lam, Lydia; Talving, Peep; Shulman, Ira; Demetriades, Demetrios.

In: Journal of Trauma and Acute Care Surgery, Vol. 81, No. 2, 01.01.2016, p. 312-318.

Research output: Contribution to journalArticle

Strumwasser, A, Speer, AL, Inaba, K, Branco, BC, Upperman, JS, Ford, H, Lam, L, Talving, P, Shulman, I & Demetriades, D 2016, 'The impact of acute coagulopathy on mortality in pediatric trauma patients', Journal of Trauma and Acute Care Surgery, vol. 81, no. 2, pp. 312-318. https://doi.org/10.1097/TA.0000000000001060
Strumwasser, Aaron ; Speer, Allison L. ; Inaba, Kenji ; Branco, Bernardino C. ; Upperman, Jeffrey S. ; Ford, Henri ; Lam, Lydia ; Talving, Peep ; Shulman, Ira ; Demetriades, Demetrios. / The impact of acute coagulopathy on mortality in pediatric trauma patients. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 81, No. 2. pp. 312-318.
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abstract = "BACKGROUND: Traumatic coagulopathy (TC) occurs in 24{\%} to 38{\%} of adults and is associated with up to a six-fold increase in mortality. This study's purpose was to determine the incidence of pediatric TC and its impact on mortality. METHODS: Aretrospective review(2004-2009) of all trauma patients from our Level I trauma centerwas performed. Coagulopathywas defined as an international normalized ratio of 1. 5 or higher or activated partial thromboplastin time of more than 36 seconds or platelets less than 100, 000/mm3. Clinical outcomes were compared between pediatric (younger than 16 years) and adult patients (≥16 years or older). RESULTS: A total of 20, 126 patients were identified (7.6{\%} pediatric, 92.4{\%} adult). Mean ± SD age was 8.7 ± 4. 8 years for pediatric patients and 37.6 ± 16.7 years for adults. The incidence of admission coagulopathy was lower in children (5.8{\%} vs. 8. 4{\%}; p < 0.001). Pediatric patients were less likely to develop coagulopathy (8.4{\%}vs. 12. 4{\%}; p < 0.001) and developed coagulopathy later than adults (102.3 ± 123.2 hours vs. 59.2 ± 1, 823. 9 hours; p < 0.001). Traumatic brain injury (TBI) and non-TBI-related coagulopathy increased in stepwise fashion with age (up to 19.5{\%}in elderly). Adult and pediatric TC was associated with increased mortality (pediatric: 14.4{\%} vs. 0. 5{\%}; p = 0.02; adult: 18. 3{\%} vs. 1. 8{\%}; p < 0.001). CONCLUSIONS: Pediatric trauma patients are less likely to present with coagulopathy, are less likely to develop coagulopathy during their admission, and tend to develop coagulopathy later than adults. If they develop coagulopathy, however, mortality increases in a stepwise fashion with age and is associated with a two- to four-fold increased risk of death.",
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AU - Speer, Allison L.

AU - Inaba, Kenji

AU - Branco, Bernardino C.

AU - Upperman, Jeffrey S.

AU - Ford, Henri

AU - Lam, Lydia

AU - Talving, Peep

AU - Shulman, Ira

AU - Demetriades, Demetrios

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N2 - BACKGROUND: Traumatic coagulopathy (TC) occurs in 24% to 38% of adults and is associated with up to a six-fold increase in mortality. This study's purpose was to determine the incidence of pediatric TC and its impact on mortality. METHODS: Aretrospective review(2004-2009) of all trauma patients from our Level I trauma centerwas performed. Coagulopathywas defined as an international normalized ratio of 1. 5 or higher or activated partial thromboplastin time of more than 36 seconds or platelets less than 100, 000/mm3. Clinical outcomes were compared between pediatric (younger than 16 years) and adult patients (≥16 years or older). RESULTS: A total of 20, 126 patients were identified (7.6% pediatric, 92.4% adult). Mean ± SD age was 8.7 ± 4. 8 years for pediatric patients and 37.6 ± 16.7 years for adults. The incidence of admission coagulopathy was lower in children (5.8% vs. 8. 4%; p < 0.001). Pediatric patients were less likely to develop coagulopathy (8.4%vs. 12. 4%; p < 0.001) and developed coagulopathy later than adults (102.3 ± 123.2 hours vs. 59.2 ± 1, 823. 9 hours; p < 0.001). Traumatic brain injury (TBI) and non-TBI-related coagulopathy increased in stepwise fashion with age (up to 19.5%in elderly). Adult and pediatric TC was associated with increased mortality (pediatric: 14.4% vs. 0. 5%; p = 0.02; adult: 18. 3% vs. 1. 8%; p < 0.001). CONCLUSIONS: Pediatric trauma patients are less likely to present with coagulopathy, are less likely to develop coagulopathy during their admission, and tend to develop coagulopathy later than adults. If they develop coagulopathy, however, mortality increases in a stepwise fashion with age and is associated with a two- to four-fold increased risk of death.

AB - BACKGROUND: Traumatic coagulopathy (TC) occurs in 24% to 38% of adults and is associated with up to a six-fold increase in mortality. This study's purpose was to determine the incidence of pediatric TC and its impact on mortality. METHODS: Aretrospective review(2004-2009) of all trauma patients from our Level I trauma centerwas performed. Coagulopathywas defined as an international normalized ratio of 1. 5 or higher or activated partial thromboplastin time of more than 36 seconds or platelets less than 100, 000/mm3. Clinical outcomes were compared between pediatric (younger than 16 years) and adult patients (≥16 years or older). RESULTS: A total of 20, 126 patients were identified (7.6% pediatric, 92.4% adult). Mean ± SD age was 8.7 ± 4. 8 years for pediatric patients and 37.6 ± 16.7 years for adults. The incidence of admission coagulopathy was lower in children (5.8% vs. 8. 4%; p < 0.001). Pediatric patients were less likely to develop coagulopathy (8.4%vs. 12. 4%; p < 0.001) and developed coagulopathy later than adults (102.3 ± 123.2 hours vs. 59.2 ± 1, 823. 9 hours; p < 0.001). Traumatic brain injury (TBI) and non-TBI-related coagulopathy increased in stepwise fashion with age (up to 19.5%in elderly). Adult and pediatric TC was associated with increased mortality (pediatric: 14.4% vs. 0. 5%; p = 0.02; adult: 18. 3% vs. 1. 8%; p < 0.001). CONCLUSIONS: Pediatric trauma patients are less likely to present with coagulopathy, are less likely to develop coagulopathy during their admission, and tend to develop coagulopathy later than adults. If they develop coagulopathy, however, mortality increases in a stepwise fashion with age and is associated with a two- to four-fold increased risk of death.

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