Background/Purpose

The utility of thrombelastography (TEG) in pediatric trauma remains unknown, and differences in coagulopathy between blunt and penetrating mechanisms are not established. We aimed to compare TEG patterns in pediatric trauma patients with blunt solid organ injuries (BSOI) and penetrating injuries to determine the role of mechanism in coagulopathy.

Methods

Highest-level pediatric trauma activations with BSOI or penetrating injuries and admission TEG at two pediatric trauma centers were included. TEG abnormalities were defined by each institution's normative values and compared separately by injury mechanism and evidence of shock (elevated SIPA) using Kruskal-Wallis or Fisher's exact tests.

Results

Of 118 patients included, 64 had BSOI and 54 had penetrating injuries. There were no significant differences in TEG abnormalities between the BSOI and penetrating injury groups. Patients with shock were more likely to have decreased alpha-angles (30.9% vs. 8.0%, p = 0.01) and decreased maximum amplitude (MA) (44.1% vs. 8.0%, p < 0.001) compared to those without shock, regardless of mechanism of injury.

Conclusions

TEG abnormalities were not significantly different between the BSOI and penetrating groups, but there were significant differences in alpha-angle and MA in those with shock, independent of mechanism. Hemodynamic status, rather than mechanism of injury, may be more predictive of coagulopathy in pediatric trauma patients.

Level of evidence/study type

Level III, retrospective

中文翻译：

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机制重要吗？比较钝性和穿透性儿科创伤患者的血栓弹力图

背景/目的

血栓弹力图 (TEG) 在儿科创伤中的效用仍然未知，钝性和穿透性机制之间凝血障碍的差异尚未确定。我们旨在比较患有钝性实体器官损伤 (BSOI) 和穿透性损伤的儿科创伤患者的 TEG 模式，以确定机制在凝血障碍中的作用。

方法

包括两个儿科创伤中心的最高级别的儿科创伤激活与 BSOI 或穿透伤和入院 TEG。TEG 异常由每个机构的规范值定义，并使用 Kruskal-Wallis 或 Fisher 精确检验通过损伤机制和休克证据（升高的 SIPA）分别进行比较。

结果

在包括的 118 名患者中，64 名 BSOI 和 54 名穿透伤。BSOI 组和穿透性损伤组之间的 TEG 异常没有显着差异。与没有休克的患者相比，休克患者更可能降低α 角（30.9% 对 8.0%，p  = 0.01）和最大振幅 (MA) 降低（44.1% 对 8.0%，p  < 0.001），无论如何的损伤机制。

结论

TEG 异常在 BSOI 组和穿透组之间没有显着差异，但在休克组中 α 角和 MA 存在显着差异，与机制无关。血流动力学状态，而不是损伤机制，可能更能预测小儿创伤患者的凝血功能障碍。

证据水平/研究类型

III 级，回顾性