Journal of pediatric surgery · 2020
Meaningful viscoelastic abnormalities in abusive and non-abusivepediatric trauma.
СтатьяНазвание и аннотация: Перевод в очереди
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Phillips Ryan, Shahi Niti, Shirek Gabrielle, Stevens Jenny, Meier Maxene, Recicar John, Lindberg Daniel M, Kim John, Moulton Steven
Аннотация
BACKGROUND/PURPOSE: There remains a lack of data on the utility of viscoelastic tests in managing abused patients. We hypothesize that abnormalities on admission thrombelastography (TEG) will differ in abused patients compared to those accidentally injured.
METHODS: Pediatric trauma patients (≤10 years old) who had an admission TEG at a Level I pediatric trauma center (2010-2020) were included and stratified into two cohorts: abuse versus accidental trauma. TEG abnormalities were based on the institution's normative values and compared between the groups.
RESULTS: Of 41 children included, 21 sustained abuse. Five abused patients and three accidentally injured patients died. Abused children showed a hypercoagulable pattern on viscoelastic testing with TEG when compared to those accidentally injured, as demonstrated by a short R-time (67% vs. 30%, p = 0.040) and an increased alpha angle (47% vs. 0%, p = 0.001). There was no significant difference in the MA and LY30 values between the two groups. In a multivariable model, only an abnormal alpha angle remained associated with abuse [odds ratio (OR) 0.17 (confidence intervals (CI) 0.02-0.92)]. In a separate multivariable model, only an abnormal MA was associated with mortality [OR 18.97 (CI 1.93-475.47), p = 0.025].
CONCLUSIONS: Our data suggest that hemostasis is significantly different in abused children relative to those who are accidentally injured.
TYPE OF STUDY: Retrospective Comparative Study.
LEVEL OF EVIDENCE: Level III.
METHODS: Pediatric trauma patients (≤10 years old) who had an admission TEG at a Level I pediatric trauma center (2010-2020) were included and stratified into two cohorts: abuse versus accidental trauma. TEG abnormalities were based on the institution's normative values and compared between the groups.
RESULTS: Of 41 children included, 21 sustained abuse. Five abused patients and three accidentally injured patients died. Abused children showed a hypercoagulable pattern on viscoelastic testing with TEG when compared to those accidentally injured, as demonstrated by a short R-time (67% vs. 30%, p = 0.040) and an increased alpha angle (47% vs. 0%, p = 0.001). There was no significant difference in the MA and LY30 values between the two groups. In a multivariable model, only an abnormal alpha angle remained associated with abuse [odds ratio (OR) 0.17 (confidence intervals (CI) 0.02-0.92)]. In a separate multivariable model, only an abnormal MA was associated with mortality [OR 18.97 (CI 1.93-475.47), p = 0.025].
CONCLUSIONS: Our data suggest that hemostasis is significantly different in abused children relative to those who are accidentally injured.
TYPE OF STUDY: Retrospective Comparative Study.
LEVEL OF EVIDENCE: Level III.