Abstract
PurposeAcute traumatic coagulopathy can result in uncontrolled haemorrhage responsible for the majority of early deaths after adult trauma. Data on the frequency, transfusion practice and outcome of severe trauma haemorrhage in paediatric patients are inconsistent.MethodsDatasets from paediatric trauma patients were retrieved from the registry of the German trauma society (TR-DGU®) between 2009 and 2016. Coagulopathy was defined by a Quick’s value < 70% (INR (international normalized ratio) > 1.4) and/or thrombocytes ≤ 100 k upon emergency room admission. Children were grouped according to age in 4 different groups (A: 1–5, B: 6–10, C: 11–15 and D: 16–17 years). Prevalence of coagulopathy was assessed. Demographics, injury severity, haemostatic management including transfusions and mortality were described.Results5351 primary admitted children ≤ 17 years with an abbreviated injury scale (AIS) ≥ 3 and complete datasets were included. The prevalence of coagulopathy was 13.7% (733/5351). The majority of the children sustained blunt trauma (more than 90% independent of age group) and a combination of traumatic brain injury (TBI) and any other trauma in more than 60% (A, C, D) and in 53.8% in group B. Coagulopathy occurred the most among the youngest (A: 18.2%), followed by all other age groups with approximately 13%. Overall mortality was the highest in the youngest (A: 40.9%) and among the youngest patients with traumatic brain injury (A: 71.4% and B: 47.1%). Transfusion of packed red blood cells (pRBCs) and fresh frozen plasma (FFPs) occurred almost in a 2:1 ratio (or less) across all age subgroups.ConclusionTraumatic haemorrhage in association with coagulopathy and severe shock is a major challenge in paediatric trauma across all age groups.
Highlights
Trauma is the leading cause of death in persons aged 1–44 years [1] and accounts for approximately 10% of all deaths in this group [2]
We report on the frequency of coagulopathy upon emergency room (ER) admission in children (≤ 17 years) with predominantly blunt injury, subsequent on transfusion practice in cases of severe trauma haemorrhage and on outcome based upon data derived from the trauma registry of the Deutsche Gesellschaft für Unfallchirurgie (German Trauma Society/TR-DGU®)
Over 230,000 trauma patients that have been entered into the TR-DGU® database between 2009 and 2016 were reviewed. 733 datasets from children aged 1–17 years were identified for further analysis (Fig. 1)
Summary
Trauma is the leading cause of death in persons aged 1–44 years [1] and accounts for approximately 10% of all deaths in this group [2]. Frequencies for ATC upon emergency room (ER) admission have been reported to range between 20 and 60% according to definition [5, 10, 11]. Data on the incidence for coagulopathy and shock in the paediatric population with predominantly blunt injury are rare. One large report including both shock and coagulopathy measures has been published for children with mostly penetrating injury [12]. We report on the frequency of coagulopathy upon ER admission in children (≤ 17 years) with predominantly blunt injury, subsequent on transfusion practice in cases of severe trauma haemorrhage and on outcome based upon data derived from the trauma registry of the Deutsche Gesellschaft für Unfallchirurgie (German Trauma Society/TR-DGU®)
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