Admission rapid thrombelastography delivers real-time %26quot;actionable%26quot; data in pediatric trauma

作者：Vogel Adam M^*; Radwan Zayde A; Cox Charles S Jr; Cotton Bryan A

来源：Journal of Pediatric Surgery, 2013, 48(6): 1371-1376.

DOI：10.1016/j.jpedsurg.2013.03.036

• Pediatric trauma
• Thrombelastography
• TEG
• Goal-directed hemostatic resuscitation

Purpose: Admission rapid thrombelastography (rTEG) is a %26quot;real-time%26quot; clinical tool used to evaluate trauma-induced coagulopathy and direct hemostatic resuscitation. The relationship of rTEG to conventional coagulation tests (CCT) and early lifesaving interventions (LSI) in pediatric trauma is unknown. %26lt;br%26gt;Methods: Severely injured patients (age %26lt;= 14 years) with an rTEG were retrospectively reviewed (8/1/2009-8/31/2011). Demographic and clinical information was collected. Spearman%26apos;s correlation and regression models were used to evaluate rTEG with respect to CCT, early transfusion, LSI, and mortality. %26lt;br%26gt;Results: Eighty-six patients were identified. The median age was 8 years, and the median injury severity score (ISS) was 21. Activated clotting time (r = 0.68), k-time (r = 0.77), and alpha-angle (r = -0.75) showed strong correlation to PTT, and maximum amplitude (MA) (r = 0.46) showed good correlation to platelet count (all p %26lt; 0.001). When controlling for age, gender, and ISS, regression analysis showed that ACT, r-value, k-time, alpha-angle, and MA predicted red blood cell and plasma transfusion within 6 h. MA (OR 0.82, 95% CI 0.70-0.96; p = 0.018) was predictive of LSI. All rTEG values, except for LY30, predicted mortality. %26lt;br%26gt;Conclusion: Admission rTEG correlates with CCT and predicts early transfusion, early LSI, and outcome in pediatric trauma. rTEG provides valuable data for goal-directed hemostatic resuscitation of critically injured children.

• 出版日期2013-6