title: Coagulopathy after severe pediatric trauma.
abstract: Trauma remains the leading cause of morbidity and mortality in the United States among children aged 1 to 21 years. The most common cause of lethality in pediatric trauma is traumatic brain injury. Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy include hypothermia, acidosis, hemodilution, and consumption of coagulation factors secondary to local activation of the coagulation system after severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of trauma-induced coagulopathy that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma.
authors.affiliation: Department of Anesthesiology, University of Alabama at Birmingham, AL.|Department of Surgery, University of Alabama at Birmingham, AL.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Christiaans
authors.affiliation: Department of Anesthesiology, University of Nebraska Medical Center, NE.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Duhachek-Stapelman
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, AL.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Russell
authors.affiliation: Department of Anesthesiology, University of Nebraska Medical Center, NE.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lisco
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, AL.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Kerby
authors.affiliation: Department of Anesthesiology, University of Alabama at Birmingham, AL.|Department of Surgery, University of Alabama at Birmingham, AL.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Pittet
mesh_terms: D000293:Adolescent; D000328:Adult; D001777:Blood Coagulation / Q000502:physiology*; D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D010372:Pediatrics; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy; D055815:Young Adult