title: Admission rapid thrombelastography delivers real-time "actionable" data in pediatric trauma.
abstract: OBJECTIVE
  Admission rapid thrombelastography (rTEG) is a "real-time" clinical tool used to evaluate trauma-induced coagulopathy and direct hemostatic resuscitation. The relationship of rTEG to conventional coagulation tests (CCT) and early lifesaving interventions (LSI) in pediatric trauma is unknown.
  
  
  METHODS
  Severely injured patients (age ≤ 14 years) with an rTEG were retrospectively reviewed (8/1/2009-8/31/2011). Demographic and clinical information was collected. Spearman's correlation and regression models were used to evaluate rTEG with respect to CCT, early transfusion, LSI, and mortality.
  
  
  RESULTS
  Eighty-six patients were identified. The median age was 8 years, and the median injury severity score (ISS) was 21. Activated clotting time (r=0.68), k-time (r=0.77), and α-angle (r=-0.75) showed strong correlation to PTT, and maximum amplitude (MA) (r=0.46) showed good correlation to platelet count (all p<0.001). When controlling for age, gender, and ISS, regression analysis showed that ACT, r-value, k-time, α-angle, and MA predicted red blood cell and plasma transfusion within 6h. MA (OR 0.82, 95% CI 0.70-0.96; p=0.018) was predictive of LSI. All rTEG values, except for LY30, predicted mortality.
  
  
  CONCLUSIONS
  Admission rTEG correlates with CCT and predicts early transfusion, early LSI, and outcome in pediatric trauma. rTEG provides valuable data for goal-directed hemostatic resuscitation of critically injured children.
authors.affiliation: Division of Pediatric Surgery, Washington University in Saint Louis School of Medicine, St. Louis, MO 63110, USA. vogelam@wudosis.wustl.edu
authors.forename: Adam M
authors.initials: AM
authors.lastname: Vogel
authors.forename: Zayde A
authors.initials: ZA
authors.lastname: Radwan
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cox
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Cotton
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010343:Patient Admission; D011379:Prognosis; D012151:Resuscitation; D012189:Retrospective Studies; D013916:Thrombelastography / Q000379:methods*; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality / Q000628:therapy
keywords: Goal-directed hemostatic resuscitation; Pediatric trauma; TEG; Thrombelastography