Thrombelastography and transfusion patterns in severely injured pediatric trauma patients with blunt solid organ injuries. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Stevens, Jenny; Pickett, Kaci; Moore, Hunter; Reppucci, Marina L.; Phillips, Ryan; Moulton, Steven; Bensard, Denis
• Is Part Of: Journal of trauma and acute care surgery. Volume 92:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: Thrombelastography -- TEG -- goal-directed resuscitation -- pediatric trauma; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000003392
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : BACKGROUND: Thrombelastography (TEG) has emerged as a useful tool to diagnose coagulopathy and guide blood product usage during trauma resuscitations. This study sought to evaluate the correlation between TEG-directed blood product administration in severely injured pediatric trauma patients with blunt solid organ injuries (BSOIs). METHODS: Patients (⩽18 years) with severe BSOIs who presented as highest-level trauma activations at two pediatric trauma centers were included. Thrombelastography results were evaluated to determine indications for blood product administration and rates of TEG-directed resuscitation. Tetrachoric correlations and regression modeling were used to correlate TEG-directed resuscitation with clinical outcomes. RESULTS: Of 64 patients who met the inclusion criteria, 32.8% (21) had elevated R times and 23.4% (15) had shortened α angles. Maximum amplitude was shortened in 29.7% (19), and percent clot lysis 30 minutes after maximum amplitude that is >3% was seen in 17.0% (9). Thrombelastography-directed resuscitation of fresh frozen plasma was followed 54.7% of the time compared with 67.2% and 81.2% for platelets and cryoprecipitate, respectively. Thrombelastography-directed resuscitation with platelets (odds ratio, 0.56; 95% confidence interval, 0.33–0.93; p = 0.03) and/or cryoprecipitate (odds ratio, 0.09; 95% confidence interval, 0.01–0.42, p = 0.003) were associated with decreased hospital length of stay and mortality, respectively. CONCLUSION: Severely injured pediatric trauma patients with BSOIs were often coagulopathic upon presentation to the emergency department. Thrombelastography-directed resuscitation with platelets and/or cryoprecipitate was followed for the majority of patients and was associated with improved outcomes. LEVEL OF EVIDENCE: Therapeutic/Care Management, level III. Abstract : Supplemental digital content is available in the text.