A Pilot Study of Viscoelastic Monitoring in Pediatric Trauma: Outcomes and Lessons Learned.

Document Type

Article

Publication Date

4-1-2018

Identifier

DOI: 10.4103/JETS.JETS_150_16; PMCID: PMC5994857

Abstract

Background: Examine the characteristics and outcomes of pediatric trauma patients at risk for coagulopathy following implementation of viscoelastic monitoring.

Materials and Methods: Injured children, agedyears, from September 7, 2014, to December 21, 2015, at risk for trauma-induced coagulopathy were identified from a single, level-1 American College of Surgeons verified pediatric trauma center. Patients were grouped by coagulation assessment: no assessment (NA), conventional coagulation testing alone (CCT), and conventional coagulation testing with rapid thromboelastography (rTEG). Coagulation assessment was provider preference with all monitoring options continuously available. Groups were compared and outcomes were evaluated including blood product utilization, Intensive Care Unit (ICU) utilization, duration of mechanical ventilation, and mortality.

Results: A total of 155 patients were identified (NA = 78, CCT = 54, and rTEG = 23). There was no difference in age, gender, race, or mechanism. In practice, rTEG patients were more severely injured, more anemic, and received more blood products and crystalloid (

Conclusions: Viscoelastic monitoring was infrequently performed, but utilized in more severely injured patients. Well-designed prospective studies in patients at high risk of coagulopathy are needed to evaluate goal-directed hemostatic resuscitation strategies in children.

Journal Title

J Emerg Trauma Shock

Volume

11

Issue

2

First Page

98

Last Page

103

Keywords

Coagulopathy; hemostatic resuscitation; pediatric trauma; rapid thromboelastography; viscoelastic monitoring

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