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A Pilot Study of Viscoelastic Monitoring in Pediatric Trauma: Outcomes and Lessons Learned

BACKGROUND: Examine the characteristics and outcomes of pediatric trauma patients at risk for coagulopathy following implementation of viscoelastic monitoring. MATERIALS AND METHODS: Injured children, aged <18 years, from September 7, 2014, to December 21, 2015, at risk for trauma-induced coagulo...

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Autores principales: Aladegbami, Bola, Choi, Pamela M., Keller, Martin S., Vogel, Adam M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994857/
https://www.ncbi.nlm.nih.gov/pubmed/29937638
http://dx.doi.org/10.4103/JETS.JETS_150_16
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author Aladegbami, Bola
Choi, Pamela M.
Keller, Martin S.
Vogel, Adam M.
author_facet Aladegbami, Bola
Choi, Pamela M.
Keller, Martin S.
Vogel, Adam M.
author_sort Aladegbami, Bola
collection PubMed
description BACKGROUND: Examine the characteristics and outcomes of pediatric trauma patients at risk for coagulopathy following implementation of viscoelastic monitoring. MATERIALS AND METHODS: Injured children, aged <18 years, from September 7, 2014, to December 21, 2015, at risk for trauma-induced coagulopathy were identified from a single, level-1 American College of Surgeons verified pediatric trauma center. Patients were grouped by coagulation assessment: no assessment (NA), conventional coagulation testing alone (CCT), and conventional coagulation testing with rapid thromboelastography (rTEG). Coagulation assessment was provider preference with all monitoring options continuously available. Groups were compared and outcomes were evaluated including blood product utilization, Intensive Care Unit (ICU) utilization, duration of mechanical ventilation, and mortality. RESULTS: A total of 155 patients were identified (NA = 78, CCT = 54, and rTEG = 23). There was no difference in age, gender, race, or mechanism. In practice, rTEG patients were more severely injured, more anemic, and received more blood products and crystalloid (P < 0.001). rTEG patients also had increased mortality with fewer ventilator and ICU-free days. Multivariate logistic regression and covariance analysis indicated that while rTEG use was not associated with mortality, it was associated with increased use of blood products, duration of mechanical ventilation, and ICU length of stay. CONCLUSIONS: Viscoelastic monitoring was infrequently performed, but utilized in more severely injured patients. Well-designed prospective studies in patients at high risk of coagulopathy are needed to evaluate goal-directed hemostatic resuscitation strategies in children.
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spelling pubmed-59948572018-06-22 A Pilot Study of Viscoelastic Monitoring in Pediatric Trauma: Outcomes and Lessons Learned Aladegbami, Bola Choi, Pamela M. Keller, Martin S. Vogel, Adam M. J Emerg Trauma Shock Original Article BACKGROUND: Examine the characteristics and outcomes of pediatric trauma patients at risk for coagulopathy following implementation of viscoelastic monitoring. MATERIALS AND METHODS: Injured children, aged <18 years, from September 7, 2014, to December 21, 2015, at risk for trauma-induced coagulopathy were identified from a single, level-1 American College of Surgeons verified pediatric trauma center. Patients were grouped by coagulation assessment: no assessment (NA), conventional coagulation testing alone (CCT), and conventional coagulation testing with rapid thromboelastography (rTEG). Coagulation assessment was provider preference with all monitoring options continuously available. Groups were compared and outcomes were evaluated including blood product utilization, Intensive Care Unit (ICU) utilization, duration of mechanical ventilation, and mortality. RESULTS: A total of 155 patients were identified (NA = 78, CCT = 54, and rTEG = 23). There was no difference in age, gender, race, or mechanism. In practice, rTEG patients were more severely injured, more anemic, and received more blood products and crystalloid (P < 0.001). rTEG patients also had increased mortality with fewer ventilator and ICU-free days. Multivariate logistic regression and covariance analysis indicated that while rTEG use was not associated with mortality, it was associated with increased use of blood products, duration of mechanical ventilation, and ICU length of stay. CONCLUSIONS: Viscoelastic monitoring was infrequently performed, but utilized in more severely injured patients. Well-designed prospective studies in patients at high risk of coagulopathy are needed to evaluate goal-directed hemostatic resuscitation strategies in children. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC5994857/ /pubmed/29937638 http://dx.doi.org/10.4103/JETS.JETS_150_16 Text en Copyright: © 2018 Journal of Emergencies, Trauma, and Shock http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Aladegbami, Bola
Choi, Pamela M.
Keller, Martin S.
Vogel, Adam M.
A Pilot Study of Viscoelastic Monitoring in Pediatric Trauma: Outcomes and Lessons Learned
title A Pilot Study of Viscoelastic Monitoring in Pediatric Trauma: Outcomes and Lessons Learned
title_full A Pilot Study of Viscoelastic Monitoring in Pediatric Trauma: Outcomes and Lessons Learned
title_fullStr A Pilot Study of Viscoelastic Monitoring in Pediatric Trauma: Outcomes and Lessons Learned
title_full_unstemmed A Pilot Study of Viscoelastic Monitoring in Pediatric Trauma: Outcomes and Lessons Learned
title_short A Pilot Study of Viscoelastic Monitoring in Pediatric Trauma: Outcomes and Lessons Learned
title_sort pilot study of viscoelastic monitoring in pediatric trauma: outcomes and lessons learned
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994857/
https://www.ncbi.nlm.nih.gov/pubmed/29937638
http://dx.doi.org/10.4103/JETS.JETS_150_16
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