• George Sakellaris, Evangelos Blevrakis, Ioannis Petrakis, Anastasia Dimopoulou, Olga Dede, Nikolaos Partalis, Athanasios Alegakis, Chrysa Seremeti, Anna Maria Spanaki, and George Briassoulis.
• Department of Pediatric Surgery, University Hospital of Heraklion, Greece.
• J Emerg Med. 2014 Nov 1;47(5):539-45.

BackgroundAcute coagulopathy associated with trauma has been recognized for decades and is a constituent of the "triad of death" together with hypothermia and acidosis.Study ObjectiveThe aim of this study was to determine to what extent coagulopathy is already established upon emergency department (ED) admission and the association with the severity of injury, impaired outcome, and mortality.MethodsNinety-one injured children were admitted to the ED in our hospital. Pediatric Trauma Score (PTS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) score were used to estimate injury severity, and organ function was assessed by the Sequential Organ Failure Assessment (SOFA) score.ResultsCoagulopathy upon pediatric intensive care unit admission was present in 33 children (39.3%): 21 males and 12 females. PTS ranged from 1 to 12 (mean 8.2) in 51 children without coagulopathy and from -1 to +11 (mean 6.8) in 33 children with coagulopathy (p = 0.087). ISS and GCS ranged from 4 to 57 (mean 28) and from 3 to 11 (mean 7.3), respectively, in the coagulopathy group, whereas in the group without coagulopathy, ISS score ranged from 4 to 41 (mean 20.5; p = 0.08) and GCS from 8 to 15 (mean 12.8; p = 0.01). SOFA ranged from 0 to 10 (mean 3.4) in children without coagulopathy and from 0 to 15 (mean 5.4) in the coagulopathy group (p = 0.002). Among 33 children with coagulopathy, 7 did not survive (21%), all with parenchymal brain damage, whereas all trauma patients without coagulopathy survived (p < 0.001).ConclusionAcute coagulopathy is present on admission to the ED and is associated with injury severity and significantly higher mortality.Copyright © 2014 Elsevier Inc. All rights reserved.

39 keywords...

hide…