Abstract
Introduction: Severe trauma accounts for a great number of deaths among children and adolescents. The diagnostic value of troponin serum levels of severely injured patients has been reported for adults, but data on pediatric polytrauma (PT) are scarce. Therefore, we conducted a retrospective monocentered study analyzing the prognostic value of troponin T (TnT) in pediatric trauma patients at the time point of hospital admission.Methods: Data of 88 polytraumatized pediatric patients admitted to the emergency room of the University Hospital of Ulm, Germany, between 2007 and 2016 were analyzed retrospectively. The data source was the written and digital patient records. Interleukin-6 (IL-6), creatine kinase activity (CK activity), and lactate and TnT levels were measured by a certified clinical diagnostic laboratory; and patients were stratified for the Injury Severity Score (ISS). The prognostic value for lung contusion, organ dysfunction, and fatal outcome was statistically explored. The study was approved by the independent ethical committee of the University of Ulm (#44/18).Results: TnT levels were significantly increased in patients after severe PT compared with mild or moderate trauma severity as assessed by ISS values. Patients with TnT levels above the cutoff showed significantly increased levels of IL-6 and CK activity and a significantly prolonged stay in the intensive care unit. However, TnT levels did not correlate with absolute ISS values. TnT levels were significantly increased in patients with chest trauma and lung contusion. The incidence of lung contusion was associated with elevation of TnT. So was the onset of organ dysfunction, defined as a Sequential Organ Failure Assessment (SOFA) score ≥ 2 and fatal outcome, with a significant enhancement of plasma levels in children with organ dysfunction and in non-survivors.Conclusion: These descriptive data suggest that evaluation of TnT on admission of multiply injured children may help in predicting severity of injury and mortality in the clinical course after trauma and thus may be a useful addition to established prognostic parameters in the future.
Highlights
Severe trauma accounts for a great number of deaths among children and adolescents
To distinguish various degrees of injury severity, all cases were stratified into four groups: Injury Severity Score (ISS) group A (ISS-A; included range: 0–15; n = 18; no PT by common definition), ISS group B (ISS-B; included range: 16–24; n = 37; mild PT), ISS group C (ISS-C; included range: 25–32; n = 18; moderate PT), and ISS group D (ISS-D; included range: >32; n = 15; severe PT)
As a main focus in this study, we observed significantly increased plasma levels of troponin T (TnT) in ISS-D group as compared with the ISS-A, ISS-B, and ISS-C groups
Summary
Severe trauma accounts for a great number of deaths among children and adolescents. The diagnostic value of troponin serum levels of severely injured patients has been reported for adults, but data on pediatric polytrauma (PT) are scarce. We conducted a retrospective monocentered study analyzing the prognostic value of troponin T (TnT) in pediatric trauma patients at the time point of hospital admission. Severe trauma from road traffic accidents is still one of the leading causes of death in both children and adolescents [1]. The role of pulmonary contusions in pediatric polytrauma (PT) has been well-characterized, the significance of cardiac impairment is not well-characterized yet, probably owing to its rarity. Blunt cardiac injury in children has been reported to cause significant arrhythmias [5] and even to lead to long-term impairment of cardiac function [6]. Autoptic studies on adults have revealed marked lesions in heart specimens of polytraumatized adults [10]
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