@article{ref1,
title="Hemostatic balance in severe trauma",
journal="Frontiers in pediatrics",
year="2020",
author="Haas, Thorsten and Cushing, Melissa M.",
volume="8",
number="",
pages="e600501-e600501",
abstract="Acute coagulopathy is prevalent in adult and pediatric trauma patients and is  associated with increased morbidity and mortality. While reasonable hypotheses have  been created to explain the underlying perturbations of adult trauma coagulopathy  (i.e., tissue factor-related increase in thrombin generation, protein C activation,  hypoperfusion, and hyperfibrinolysis), only a small number of studies have been  performed to prove whether these mechanisms can likewise be detected in pediatric  trauma patients. In addition, severe hypofibrinogenemia (<100 mg/dL) is a frequent  finding in pediatric trauma patients (>20%). Although the probability of  life-threatening coagulopathy is low with minor to moderate injury, it is present in  almost all patients with an injury severity score >25, hypotension, hypothermia, and  acidosis. As these multifactorial changes in hemostasis cannot be adequately and  rapidly measured using standard laboratory testing, the use of viscoelastic  measurements has been established in adult trauma management, but prospective  studies in children are urgently needed. Apart from diagnostic challenges, several  studies have focused on the impact of blood product ratios on the treatment of  massively bleeding pediatric trauma patients. The majority of these studies were  unable to show improved survival by using higher plasma to red blood cell ratios or  higher platelet to red blood cells ratios, but there are no published randomized  trials to definitively answer this question. A goal-directed transfusion protocol  using viscoelastic tests together with early substitution with an antifibrinolytic  and fibrinogen replacement is a promising alternative to traditional ratio-based  interventions. Another crucial factor in treating trauma-induced coagulopathy is the  early detection of hypofibrinogenemia, a common condition in massively transfused  patients. Early treatment of hypofibrinogenemia is associated with improved  morbidity and mortality in adults, but needs to be further studied in future  pediatric trials. Pediatric trauma patients are not only threatened by  coagulopathy-related bleeding but are also at higher risk for venous  thromboembolism. Pediatric trauma patients with brain injury, central venous  catheters, immobilization, or surgical procedures are at highest risk for developing  a deep venous thrombosis. There are no specific pediatric guidelines established to  prevent venous thromboembolism in children suffering from traumatic injury.<p /> <p>Language: en</p>",
language="en",
issn="2296-2360",
doi="10.3389/fped.2020.600501",
url="http://dx.doi.org/10.3389/fped.2020.600501"
}