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Coagulopathy After Severe Pediatric Trauma

Christiaans, Sarah C.*†; Duhachek-Stapelman, Amy L.; Russell, Robert T.; Lisco, Steven J.; Kerby, Jeffrey D.; Pittet, Jean-François*†

doi: 10.1097/SHK.0000000000000151
Review Articles
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ABSTRACT Trauma remains the leading cause of morbidity and mortality in the United States among children aged 1 to 21 years. The most common cause of lethality in pediatric trauma is traumatic brain injury. Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy include hypothermia, acidosis, hemodilution, and consumption of coagulation factors secondary to local activation of the coagulation system after severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of trauma-induced coagulopathy that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma.

*Departments of Anesthesiology, and Surgery, University of Alabama at Birmingham, Birmingham, Alabama; and Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska

Received 21 Oct 2013; first review completed 14 Nov 2013; accepted in final form 5 Feb 2014

Address reprint requests to Jean-François Pittet, MD, Department of Anesthesiology, University of Alabama at Birmingham, 619 South 19th St, JT926, Birmingham AL 35249. E-mail:

Sarah C. Christiaans and Amy L. Duhachek-Stapelman contributed equally to this article.

This study was supported by the National Institutes of Health (grant no. RO1 GM086416 to J.F.P.) and by UAB Kirklin (grant to R.T.R.).

© 2014 by the Shock Society