Citation

Kalkwarf KJ, Jensen SD, Allukian M, Harting MT, Cox CS, Fox EE, Wade CE, Cotton BA. J. Am. Coll. Surg. 2018; 226(4): 662-667.

Affiliation

Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, Texas.

Copyright

(Copyright © 2018, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jamcollsurg.2017.12.034

PMID

29325878

Abstract

BACKGROUND: Objective parameters predicting futility of care in severely injured pediatric patients are lacking. While futility of care has been investigated in a limited number of studies in trauma patients, none of these studies achieves a 100% success rate in a large cohort of pediatric patients. The purpose of the current study was to identify extreme laboratory values that could be used to predict 100% mortality in severely injured children. STUDY DESIGN: Registry-based, historical cohort of all severely injured children (level 1 trauma, <16 years old), who were not dead on arrival, between January 2010 and December 2016 from a single level 1 trauma center. Extreme arrival laboratory data were evaluated both alone and in conjunction with traumatic brain injury (TBI).

RESULTS: 1292 patients met inclusion criteria, of which 1169 survived (90.5%) and 123 died (9.5%). Those who died were significantly younger, with higher a head AIS and overall ISS. Single extreme laboratory values were identified that predicted mortality perfectly (100% PPV): INR ≥3.0, pH ≤6.95, base excess ≤-22, platelet count ≤30 K, hemoglobin ≤5.0 g/dL, r-TEG MA ≤30 mm, and r-TEG lysis at 30 min ≥50%. When two laboratory values or the presence of TBI was added, lower thresholds for futility were noted.

CONCLUSIONS: Extreme admission laboratory values are capable of predicting 100% mortality and futility in further care in severely injured children with a high level of accuracy. Validation of these single center findings is warranted and, if supported, should initiate a discussion within the pediatric trauma community regarding application and cessation of resuscitation efforts to optimize resource utilization.

Copyright © 2018. Published by Elsevier Inc.

Language: en