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Citation
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Stevens J, Pickett K, Moore H, Reppucci ML, Phillips R, Moulton S, Bensard D. J. Trauma Acute Care Surg. 2021; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Thrombelastography (TEG) has emerged as a useful tool to diagnose coagulopathy and guide blood product usage during trauma resuscitations. This study sought to evaluate the correlation between TEG-directed blood product administration in severely injured pediatric trauma patients with blunt solid organ injuries (BSOI).
METHODS: Patients (<18 years) with severe BSOI who presented as highest-level trauma activations at two pediatric trauma centers (PTC) were included. TEG results were evaluated to determine indications for blood product administration and rates of TEG-directed resuscitation. Tetrachoric correlations and regression modeling were used to correlate TEG-directed resuscitation with clinical outcomes.
RESULTS: Of 64 patients who met inclusion criteria, 32.8% (21) had elevated R-times and 23.4% (15) had shortened alpha-angles. MA was shortened in 29.7% (19) and LY30 > 3% was seen in 17.0% (9). TEG-directed resuscitation of FFP was followed 54.7% of the time compared to 67.2% and 81.2% for platelets and cryoprecipitate, respectively. TEG-directed resuscitation with platelets (OR 0.56, 95% CI, 0.33, 0.93, p = 0.03) and/or cryoprecipitate (OR 0.09, 95% CI, 0.01, 0.42, p = 0.003) were associated with decreased hospital length of stay and mortality, respectively.
CONCLUSION: Severely injured pediatric trauma patients with BSOI were often coagulopathic upon presentation to the Emergency Department. TEG-directed resuscitation with platelets and/or cryoprecipitate was followed for the majority of patients and was associated with improved outcomes. LEVEL OF EVIDENCE/TYPE OF STUDY: Level III, retrospective comparative study.
Language: en |