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Abstract
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BACKGROUND: The role of age and sex in mediating coagulation characteristics in injured children is not well defined. We hypothesize that thromboelastography (TEG) profiles are equivalent across sex in younger children and diverge after puberty.
METHODS: Consecutive trauma patients age < 18 were identified from a university-affiliated, level I, pediatric trauma center (2016-2020) database. Demographics, injury characteristics, and TEG parameters were recorded. Children were categorized by sex and age (younger: ≤10 years, older: ≥11 years). Baseline characteristics, outcomes, and TEG parameters were compared using nonparametric tests as appropriate. To account for the effects of confounding variables, analysis of covariance (ANCOVA) was performed controlling for injury severity score (ISS), admission Glasgow Coma Score (GCS), and pediatric age-adjusted shock index (SIPA).
RESULTS: 647 subjects were identified (70.2% male, median (IQR) ISS 10 (5-24), blunt mechanism 75.4%). Among 395 younger children (<10 years), there were no differences in TEG characteristics between sexes. Among 252 adolescents (> 11 years), males had greater K times (1.8 vs 1.4 min, p < 0.001), decreased alpha angles (69.6o vs73.7o, p < 0.001), and lower maximum amplitudes (59.4 vs 61.5 mm, p = 0.01). Fibrinolysis was significantly lower in older females compared to younger females (0.4% vs. 1.5%, p < 0.001) and age-matched males (0.4% vs. 1.0%, p = 0.02). Compared to younger male children, adolescent males had greater K times (1.8 vs 1.4 min, p < 0.001), decreased alpha angles (73.5o vs. 69.6o, p < 0.001), lower maximum amplitudes (59.4 vs 62 mm, p < 0.001) and less fibrinolysis (1.0% vs 1.3%, p = 0.03). This interaction persisted after controlling for ISS, GCS and SIPA.
CONCLUSIONS: Sex dimorphisms in TEG coagulation profiles appear after puberty. This divergence appears to be driven by a shift in male coagulation profiles to a relatively hypocoagulable state and female coagulation profiles to a relatively hypercoagulable state after puberty. LEVEL OF EVIDENCE: III.
Language: en |