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Coagulopathy and shock on admission is associated with mortality for children with traumatic injuries at combat support hospitals*

Patregnani, Jason T. MD; Borgman, Matthew A. MD; Maegele, Marc MD; Wade, Charles E. PhD; Blackbourne, Lorne H. MD; Spinella, Philip C. MD

Author Information

From the Connecticut Children’s Medical Center (JTP), Hartford, CT; Children’s Hospital Boston (MAB), Boston, MA, and Brooke Army Medical Center, San Antonio, TX; Cologne University Medical Center (MM), Cologne, Germany; the University of Texas (CEN), Center for Translational Injury Research, Houston, TX; U.S. Army Institute of Surgical Research (LHB, PCS), San Antonio, TX; Blood Systems Research Institute (PCS), San Francisco, CA; and Washington University in St. Louis (PCS), St. Louis, MO.

*See also p. 353.

The views and opinions expressed in this article are those of the authors and do not reflect the official policy or position of the Army Medical Department, Department of the Army, the Department of Defense, or the U.S. Government. The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

Pediatric Critical Care Medicine 13(3):p 273-277, May 2012. | DOI: 10.1097/PCC.0b013e31822f1727

Abstract

Objective:

In adults, early traumatic coagulopathy and shock are both common and independently associated with mortality. There are little data regarding both the incidence and association of early coagulopathy and shock on outcomes in pediatric patients with traumatic injuries. Our objective was to determine whether coagulopathy and shock on admission are independently associated with mortality in children with traumatic injuries.

Methods:

A retrospective review of the Joint Theater Trauma Registry from U.S. combat support hospitals in Iraq and Afghanistan from 2002 to 2009 was performed. Coagulopathy was defined as an international normalized ratio of ≥1.5 and shock as a base deficit of ≥6. Laboratory values were measured on admission. Primary outcome was inhospital mortality. Univariate analyses were performed on all admission variables followed by reverse stepwise multivariate logistic regression to determine independent associations.

Setting:

Combat support hospitals in Iraq and Afghanistan.

Patients:

Patients <18 yrs of age with Injury Severity Score, international normalized ratio, base deficit, and inhospital mortality were included. Of 1998 in the cohort, 744 (37%) had a complete set of data for analysis.

Intervention:

None.

Measurements and Main Results:

The incidence of early coagulopathy and shock were 27% and 38.3% and associated with mortality of 22% and 16.8%, respectively. After multivariate logistic regression, early coagulopathy had an odds ratio of 2.2 (95% confidence interval 1.1–4.5) and early shock had an odds ratio of 3.0 (95% confidence interval 1.2–7.5) for mortality. Patients with coagulopathy and shock had an odds ratio of 3.8 (95% confidence interval 2.0–7.4) for mortality.

Conclusions:

In children with traumatic injuries treated at combat support hospitals, coagulopathy and shock on admission are common and independently associated with a high incidence of inhospital mortality. Future studies are needed to determine whether more rapid and accurate methods of measuring coagulopathy and shock as well as if early goal-directed treatment of these states can improve outcomes in children.

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Coagulopathy and shock on admission is associated with mortality for children with traumatic injuries at combat support hospitals*