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首页> 外文期刊>Journal of the American College of Surgeons >Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Use, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents
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Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Use, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents

机译：入院急性创伤性凝血病治疗强度，资源使用和死亡率的患病率和影响：评估956名严重受伤的儿童和青少年

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BACKGROUND: Acute coagulopathy of trauma in children is of potential importance to clinical outcomes, but knowledge is limited and has only been investigated using conventional coagulation testing. The purpose of this study was to assess the prevalence and impact of arrival coagulopathy, determined by viscoelastic hemostatic testing, in severely injured children. STUDY DESIGN: Pediatric patients (younger than 17 years of age) who were admitted January 2010 to May 2016 and met highest-level trauma activation were included. Patients were divided into 2 groups (coagulopathy and controls) based on arrival rapid thrombelastography values. Coagulopathy was defined as the presence of any of the following on rapid thrombelastography: activated clotting time > 128 seconds, alpha-angle <65 degrees, maximum amplitude <55 mm, and lysis at 30 minutes from 20-mm amplitude >3%. Logistic regression was used to adjust for age, sex, blood pressure, mechanism, and injury severity. RESULTS:Nine hundred and fifty-six patients met inclusion; 507 (57%) were coagulopathic and 449 (43%) were not (noncoagulopathic and control cohort). Coagulopathic patients were younger (median 14 vs 15 years) and more likely to be male (68% vs 60%) and Hispanic (38% vs 31%) (all p < 0.05). Coagulopathic patients received more RBC and plasma transfusions and had fewer ICU and ventilator-free days and higher mortality (12% vs 3%; all p < 0.05). Of these 956, 197 (21%) sustained severe brain injury—123 (62%) were coagulopathic and 74 (38%) were noncoagulopathic. The mortality difference was even greater for coagulopathic head injuries (31% vs 10%; p = 0.002). Adjusting for confounders, admission coagulopathy was an independent predictor of death, with an odds ratio of 3.67 (95% CI 1.768 to 7.632; p < 0.001). CONCLUSIONS: Almost 60% of severely injured children and adolescents arrive with evidence of acute traumatic coagulopathy. The presence of admission coagulopathy is associated with high mortality in children, especially among those with head injuries.
机译：背景：儿童创伤的急性凝血病是对临床结果的重要性，但知识受到限制，并且只有使用常规凝血检测进行调查。本研究的目的是评估到达凝血病的患病率和影响，由粘弹性止血试验确定，严重受伤的儿童。研究设计：2010年1月至2016年5月入院的儿科患者（年龄小于17岁），包括符合最高水平的创伤激活。基于到达快速缩血值的情况下，患者分为2组（凝血病和对照）。凝结病变被定义为在快速血栓缩影上的以下任何一种：活化凝血时间> 128秒，α-角度<65度，最大幅度<55mm，以及30分钟的裂解，较20mm振幅> 3％。 Logistic回归用于调整年龄，性别，血压，机制和伤害严重程度。结果：九百五十六名患者均纳入; 507（57％）是凝血性疗法，449（43％）不是（非血管病和对照队列）。凝血性患者患者较年轻（中位数14 vs 15岁），更有可能是雄性（68％vs 60％）和西班牙裔（38％vs 31％）（所有P <0.05）。凝血性患者接受了更多的RBC和血浆输血，并且没有较少的ICU和呼吸机的天，死亡率更高（12％vs 3％;所有P <0.05）。其中956,197（21％）持续严重的脑损伤-123（62％）是凝血性疗法，74（38％）是非血换的。凝血性头部损伤的死亡率甚至更大（31％vs 10％; p = 0.002）。调整混凝剂，入学凝结病是一种独立的死亡预测因子，比率比为3.67（95％CI 1.768至7.632; P <0.001）。结论：近60％严重受伤的儿童和青少年患有急性创伤凝血病的证据。入院凝结病的存在与儿童的高死亡率有关，特别是在头部受伤的人中。

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