Coagulation testing in pediatric blunt trauma patients

James F Holmes Jr, H. C. Goodwin, C. Land, Nathan Kuppermann

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objectives: To determine the prevalence of abnormal coagulation studies and to identify variables associated with markedly elevated coagulation studies in children with blunt trauma. Methods: We reviewed the medical records of all patients < 15 years old hospitalized at a Level 1 trauma center for either blunt head or torso trauma over a 4-year period. Data from each patient's emergency department (ED) presentation were abstracted. ED coagulation studies were defined prior to data analysis as elevated if the international normalized ratio (INR) was ≥1.2 or partial thromboplastin time (PTT) was ≥33.0 seconds and markedly elevated if the INR was ≥1.5 or PTT was ≥40 seconds. Variables associated with markedly elevated coagulation studies in a univariate analysis (P < 0.05) were entered into a backward elimination logistic regression analysis to identify variables independently associated with markedly elevated coagulation studies. Results: A total of 1082 patients' records were reviewed, and the 830 (77 %) patients with coagulation studies obtained composed the study population. Elevated coagulation studies were detected in 232 (28%) patients, and 49 (6%) of these were found to be markedly elevated. In the multivariate analysis, a GCS ≤13 (odds ratio [OR] 8.7, 95% confidence interval [CI] 4.3,17.7), low systolic blood pressure (OR 4.0, 95% CI 1.6, 9.9), open/multiple bony fractures (OR 2.9, 95% CI 1.4, 6.2), and major tissue wounds (OR 2.8, 95% CI 1.4, 5.6) were independently associated with markedly elevated coagulation studies. Conclusion: Hospitalized pediatric blunt trauma patients frequently have minor elevations in ED coagulation studies. Marked elevations occur infrequently and are independently associated with a GCS ≤13, low systolic blood pressure, open/multiple bony fractures, and major tissue wounds.

Original languageEnglish (US)
Pages (from-to)324-328
Number of pages5
JournalPediatric Emergency Care
Volume17
Issue number5
DOIs
StatePublished - 2001

Fingerprint

Pediatrics
Wounds and Injuries
Odds Ratio
Confidence Intervals
Hospital Emergency Service
International Normalized Ratio
Partial Thromboplastin Time
Hypotension
Blood Pressure
Torso
Trauma Centers
Medical Records
Multivariate Analysis
Logistic Models
Regression Analysis
Population
Multiple Fractures

Keywords

  • Blunt trauma
  • Coagulation tests

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nursing(all)
  • Emergency Medicine

Cite this

Coagulation testing in pediatric blunt trauma patients. / Holmes Jr, James F; Goodwin, H. C.; Land, C.; Kuppermann, Nathan.

In: Pediatric Emergency Care, Vol. 17, No. 5, 2001, p. 324-328.

Research output: Contribution to journalArticle

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abstract = "Objectives: To determine the prevalence of abnormal coagulation studies and to identify variables associated with markedly elevated coagulation studies in children with blunt trauma. Methods: We reviewed the medical records of all patients < 15 years old hospitalized at a Level 1 trauma center for either blunt head or torso trauma over a 4-year period. Data from each patient's emergency department (ED) presentation were abstracted. ED coagulation studies were defined prior to data analysis as elevated if the international normalized ratio (INR) was ≥1.2 or partial thromboplastin time (PTT) was ≥33.0 seconds and markedly elevated if the INR was ≥1.5 or PTT was ≥40 seconds. Variables associated with markedly elevated coagulation studies in a univariate analysis (P < 0.05) were entered into a backward elimination logistic regression analysis to identify variables independently associated with markedly elevated coagulation studies. Results: A total of 1082 patients' records were reviewed, and the 830 (77 {\%}) patients with coagulation studies obtained composed the study population. Elevated coagulation studies were detected in 232 (28{\%}) patients, and 49 (6{\%}) of these were found to be markedly elevated. In the multivariate analysis, a GCS ≤13 (odds ratio [OR] 8.7, 95{\%} confidence interval [CI] 4.3,17.7), low systolic blood pressure (OR 4.0, 95{\%} CI 1.6, 9.9), open/multiple bony fractures (OR 2.9, 95{\%} CI 1.4, 6.2), and major tissue wounds (OR 2.8, 95{\%} CI 1.4, 5.6) were independently associated with markedly elevated coagulation studies. Conclusion: Hospitalized pediatric blunt trauma patients frequently have minor elevations in ED coagulation studies. Marked elevations occur infrequently and are independently associated with a GCS ≤13, low systolic blood pressure, open/multiple bony fractures, and major tissue wounds.",
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N2 - Objectives: To determine the prevalence of abnormal coagulation studies and to identify variables associated with markedly elevated coagulation studies in children with blunt trauma. Methods: We reviewed the medical records of all patients < 15 years old hospitalized at a Level 1 trauma center for either blunt head or torso trauma over a 4-year period. Data from each patient's emergency department (ED) presentation were abstracted. ED coagulation studies were defined prior to data analysis as elevated if the international normalized ratio (INR) was ≥1.2 or partial thromboplastin time (PTT) was ≥33.0 seconds and markedly elevated if the INR was ≥1.5 or PTT was ≥40 seconds. Variables associated with markedly elevated coagulation studies in a univariate analysis (P < 0.05) were entered into a backward elimination logistic regression analysis to identify variables independently associated with markedly elevated coagulation studies. Results: A total of 1082 patients' records were reviewed, and the 830 (77 %) patients with coagulation studies obtained composed the study population. Elevated coagulation studies were detected in 232 (28%) patients, and 49 (6%) of these were found to be markedly elevated. In the multivariate analysis, a GCS ≤13 (odds ratio [OR] 8.7, 95% confidence interval [CI] 4.3,17.7), low systolic blood pressure (OR 4.0, 95% CI 1.6, 9.9), open/multiple bony fractures (OR 2.9, 95% CI 1.4, 6.2), and major tissue wounds (OR 2.8, 95% CI 1.4, 5.6) were independently associated with markedly elevated coagulation studies. Conclusion: Hospitalized pediatric blunt trauma patients frequently have minor elevations in ED coagulation studies. Marked elevations occur infrequently and are independently associated with a GCS ≤13, low systolic blood pressure, open/multiple bony fractures, and major tissue wounds.

AB - Objectives: To determine the prevalence of abnormal coagulation studies and to identify variables associated with markedly elevated coagulation studies in children with blunt trauma. Methods: We reviewed the medical records of all patients < 15 years old hospitalized at a Level 1 trauma center for either blunt head or torso trauma over a 4-year period. Data from each patient's emergency department (ED) presentation were abstracted. ED coagulation studies were defined prior to data analysis as elevated if the international normalized ratio (INR) was ≥1.2 or partial thromboplastin time (PTT) was ≥33.0 seconds and markedly elevated if the INR was ≥1.5 or PTT was ≥40 seconds. Variables associated with markedly elevated coagulation studies in a univariate analysis (P < 0.05) were entered into a backward elimination logistic regression analysis to identify variables independently associated with markedly elevated coagulation studies. Results: A total of 1082 patients' records were reviewed, and the 830 (77 %) patients with coagulation studies obtained composed the study population. Elevated coagulation studies were detected in 232 (28%) patients, and 49 (6%) of these were found to be markedly elevated. In the multivariate analysis, a GCS ≤13 (odds ratio [OR] 8.7, 95% confidence interval [CI] 4.3,17.7), low systolic blood pressure (OR 4.0, 95% CI 1.6, 9.9), open/multiple bony fractures (OR 2.9, 95% CI 1.4, 6.2), and major tissue wounds (OR 2.8, 95% CI 1.4, 5.6) were independently associated with markedly elevated coagulation studies. Conclusion: Hospitalized pediatric blunt trauma patients frequently have minor elevations in ED coagulation studies. Marked elevations occur infrequently and are independently associated with a GCS ≤13, low systolic blood pressure, open/multiple bony fractures, and major tissue wounds.

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