Journal of Emergencies, Trauma, and Shock

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 11  |  Issue : 2  |  Page : 98--103

A pilot study of viscoelastic monitoring in pediatric trauma: Outcomes and lessons learned


Bola Aladegbami1, Pamela M Choi1, Martin S Keller2, Adam M Vogel3 
1 Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
2 Department of Surgery, Division of Pediatric Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA
3 Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Childresn's Hospital, Houston, Texas 77030, USA

Correspondence Address:
Adam M Vogel
Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, Texas 77030
USA

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.


How to cite this article:
Aladegbami B, Choi PM, Keller MS, Vogel AM. A pilot study of viscoelastic monitoring in pediatric trauma: Outcomes and lessons learned.J Emerg Trauma Shock 2018;11:98-103


How to cite this URL:
Aladegbami B, Choi PM, Keller MS, Vogel AM. A pilot study of viscoelastic monitoring in pediatric trauma: Outcomes and lessons learned. J Emerg Trauma Shock [serial online] 2018 [cited 2022 Sep 24 ];11:98-103
Available from: https://www.onlinejets.org/article.asp?issn=0974-2700;year=2018;volume=11;issue=2;spage=98;epage=103;aulast=Aladegbami;type=0