Rotational thromboelastometry predicts transfusion and disability in pediatric trauma

• Published in: The journal of trauma and acute care surgery Vol. 88; no. 1; p. 134
• Main Authors: Cunningham, Aaron J, Condron, Mary, Schreiber, Martin A, Azarow, Kenneth, Hamilton, Nicholas A, Downie, Katie, Long, William B, Maxwell, Bryan G, Jafri, Mubeen A
• Format: Journal Article
• Language: English
• Published: United States 01.01.2020
• Subjects: Adolescent; Blood Coagulation Disorders - diagnosis; Blood Coagulation Disorders - etiology; Blood Coagulation Disorders - mortality; Blood Coagulation Disorders - therapy; Blood Component Transfusion - methods; Blood Component Transfusion - standards; Blood Component Transfusion - statistics & numerical data; Child; Clinical Decision-Making; Female; Hospital Mortality; Humans; Injury Severity Score; Male; Practice Guidelines as Topic; Predictive Value of Tests; Prognosis; Retrospective Studies; ROC Curve; Thrombelastography - methods; Trauma Centers - statistics & numerical data; Treatment Outcome; Wounds and Injuries - complications; Wounds and Injuries - diagnosis; Wounds and Injuries - mortality; Wounds and Injuries - therapy
• ISSN: 2163-0763
• DOI: 10.1097/TA.0000000000002533

Trauma-induced coagulopathy seen on rotational thromboelastometry (ROTEM) is associated with poor outcomes in adults; however, this relationship is poorly understood in the pediatric population. We sought to define thresholds for product-specific transfusion and evaluate the prognostic efficacy of ROTEM in injured children. Demographics, ROTEM, and clinical outcomes from severely injured children (age, < 18 years) admitted to a Level I trauma center between 2014 and 2018 were retrospectively analyzed. Receiver operating characteristic curves were plotted and Youden indexes were calculated against the endpoint of packed red blood cell transfusion to identify thresholds for intervention. The ROTEM parameters were compared against the clinical outcomes of mortality or disability at discharge. Ninety subjects were reviewed. Increased tissue factor-triggered extrinsic pathway (EXTEM) clotting time (CT) >84.5 sec (p = 0.049), decreased EXTEM amplitude at 10 minutes (A10) <43.5 mm (p = 0.025), and decreased EXTEM maximal clot firmness (MCF) <64.5 mm (p = 0.026) were associated with need for blood product transfusion. Additionally, EXTEM CT longer than 68.5 seconds was associated with mortality or disability at discharge. Coagulation dysregulation on thromboelastometry is associated with disability and mortality in children. Based on our findings, we propose ROTEM thresholds: plasma transfusion for EXTEM CT longer than 84.5 seconds, fibrinogen replacement for EXTEM A10 less than 43.5 mm, and platelet transfusion for EXTEM MCF less than 64.5 mm. Prognostic, Level III; Therapeutic, Level IV.