Trauma induced clotting factor depletion in severely injured children: a single center observational study
Abstract Background Coagulopathy following severe trauma contributes significantly to mortality. Impaired clotting factors have been observed in adult trauma patients, but in pediatric trauma victims their activity has not yet been investigated. Methods Sixteen pediatric trauma patients were evaluat...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-05-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13017-020-00311-6 |
| _version_ | 1819153300805648384 |
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| author | Manuel Burggraf Christina Polan Martin Husen Bastian Mester Alexander Wegner Daniel Spodeck Marcel Dudda Max Daniel Kauther |
| author_facet | Manuel Burggraf Christina Polan Martin Husen Bastian Mester Alexander Wegner Daniel Spodeck Marcel Dudda Max Daniel Kauther |
| author_sort | Manuel Burggraf |
| collection | DOAJ |
| description | Abstract Background Coagulopathy following severe trauma contributes significantly to mortality. Impaired clotting factors have been observed in adult trauma patients, but in pediatric trauma victims their activity has not yet been investigated. Methods Sixteen pediatric trauma patients were evaluated according to the ISS and assigned to two cohorts. An additional control group (CO; n = 10) was formed. Routine coagulation parameters and the soluble clotting factors (F) were tested. Nonparametric data was analyzed using the Mann-Whitney U test. Results are reported as median and interquartile range. Results The ISS of severely (SI, n = 8) and mildly (MI, n = 8) injured children differed significantly (25 [19–28] vs. 5 [4–6]; p < 0.001). INR was elevated in the SI cohort only when compared to the CO (1.21 [1.04-1.58] vs. 0.96 [0.93-1.00]; p = 0.001). Differences between SI and MI were found for FII (67 [53-90] vs. 82 [76-114] %; p = 0.028), FV (76 [47-88] vs. 92 [82-99] %; p = 0.028), and FXIII (67 [62-87] vs. 90 [77-102] %; p = 0.021). Comparison of the SI with the CO (FII 122 [112-144] %; p < 0.001; FV 123 [100-142] %; p = 0.002; and FXIII 102 [79-115] %; p = 0.006) also revealed a reduction in the activity of these factors. Furthermore, fibrinogen (198 [80-242] vs. 296 [204-324] mg/dl; p = 0.034), FVII (71 [63-97] vs. 114 [100-152] %; p = 0.009), FIX (84 [67-103] vs. 110 [90-114] %; p = 0.043), and FX (70 [61-85] vs. 122 [96-140] %; p = 0.001) were reduced in the SI in comparison with the CO. Finally, FVIII was considerably, yet not significantly, increased in both patient cohorts (235 [91-320] % and 197 [164-238] %, respectively). Conclusions This study proves that children suffer a depletion of clotting factors following severe injury which basically reflects the findings for adult trauma patients. Attempts to correct the impaired clotting factor activity could be based on a specific hemostatic therapy involving administration of coagulation factors. Nevertheless, therapeutic implications need to be investigated in future studies. |
| first_indexed | 2024-12-22T15:03:00Z |
| format | Article |
| id | doaj.art-a99a6d90f53b44bba7ffe657d7deccae |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-12-22T15:03:00Z |
| publishDate | 2020-05-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-a99a6d90f53b44bba7ffe657d7deccae2022-12-21T18:22:04ZengBMCWorld Journal of Emergency Surgery1749-79222020-05-011511910.1186/s13017-020-00311-6Trauma induced clotting factor depletion in severely injured children: a single center observational studyManuel Burggraf0Christina Polan1Martin Husen2Bastian Mester3Alexander Wegner4Daniel Spodeck5Marcel Dudda6Max Daniel Kauther7Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-EssenDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-EssenDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-EssenDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-EssenDepartment of Orthopedics and Trauma Surgery, University Hospital Essen, University of Duisburg-EssenDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-EssenDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-EssenDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-EssenAbstract Background Coagulopathy following severe trauma contributes significantly to mortality. Impaired clotting factors have been observed in adult trauma patients, but in pediatric trauma victims their activity has not yet been investigated. Methods Sixteen pediatric trauma patients were evaluated according to the ISS and assigned to two cohorts. An additional control group (CO; n = 10) was formed. Routine coagulation parameters and the soluble clotting factors (F) were tested. Nonparametric data was analyzed using the Mann-Whitney U test. Results are reported as median and interquartile range. Results The ISS of severely (SI, n = 8) and mildly (MI, n = 8) injured children differed significantly (25 [19–28] vs. 5 [4–6]; p < 0.001). INR was elevated in the SI cohort only when compared to the CO (1.21 [1.04-1.58] vs. 0.96 [0.93-1.00]; p = 0.001). Differences between SI and MI were found for FII (67 [53-90] vs. 82 [76-114] %; p = 0.028), FV (76 [47-88] vs. 92 [82-99] %; p = 0.028), and FXIII (67 [62-87] vs. 90 [77-102] %; p = 0.021). Comparison of the SI with the CO (FII 122 [112-144] %; p < 0.001; FV 123 [100-142] %; p = 0.002; and FXIII 102 [79-115] %; p = 0.006) also revealed a reduction in the activity of these factors. Furthermore, fibrinogen (198 [80-242] vs. 296 [204-324] mg/dl; p = 0.034), FVII (71 [63-97] vs. 114 [100-152] %; p = 0.009), FIX (84 [67-103] vs. 110 [90-114] %; p = 0.043), and FX (70 [61-85] vs. 122 [96-140] %; p = 0.001) were reduced in the SI in comparison with the CO. Finally, FVIII was considerably, yet not significantly, increased in both patient cohorts (235 [91-320] % and 197 [164-238] %, respectively). Conclusions This study proves that children suffer a depletion of clotting factors following severe injury which basically reflects the findings for adult trauma patients. Attempts to correct the impaired clotting factor activity could be based on a specific hemostatic therapy involving administration of coagulation factors. Nevertheless, therapeutic implications need to be investigated in future studies.http://link.springer.com/article/10.1186/s13017-020-00311-6CoagulationTraumaClotting factorsCoagulopathyChildren |
| spellingShingle | Manuel Burggraf Christina Polan Martin Husen Bastian Mester Alexander Wegner Daniel Spodeck Marcel Dudda Max Daniel Kauther Trauma induced clotting factor depletion in severely injured children: a single center observational study World Journal of Emergency Surgery Coagulation Trauma Clotting factors Coagulopathy Children |
| title | Trauma induced clotting factor depletion in severely injured children: a single center observational study |
| title_full | Trauma induced clotting factor depletion in severely injured children: a single center observational study |
| title_fullStr | Trauma induced clotting factor depletion in severely injured children: a single center observational study |
| title_full_unstemmed | Trauma induced clotting factor depletion in severely injured children: a single center observational study |
| title_short | Trauma induced clotting factor depletion in severely injured children: a single center observational study |
| title_sort | trauma induced clotting factor depletion in severely injured children a single center observational study |
| topic | Coagulation Trauma Clotting factors Coagulopathy Children |
| url | http://link.springer.com/article/10.1186/s13017-020-00311-6 |
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