title: [Effect of thrombelastography in the diagnosis of disseminated intravascular coagulation in children].
abstract: OBJECTIVE
  To study the effect of thrombelastography (TEM) in the diagnosis of disseminated intravascular coagulation (DIC) in children.
  
  
  METHODS
  The data of 117 children suffering from DIC in the pediatric intensive care unit (PICU) and Cardiologic ICU (CICU) in the authors' hospital from January 2010 to June 2012 were collected. Ninety-four children without DIC were enrolled into the control group. The platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimers and TEM were determined. The sensitivity and specificity of TEM were measured and the relevance of TEM and DIC was investigated to evaluate the effect of TEM and the conventional tests of the coagulation system in the diagnosis of DIC in children.
  
  
  RESULTS
  The average R reaction time in the DIC group was significantly longer than that in the control group[(13.3 ± 3.3)s vs. (4.5 ± 2.6)s, P = 0.000 5], and the average α-angle in the DIC group was smaller than that in the control group significantly (37.2° ± 1.4° vs. 55.6° ± 3.8°, P = 0.001 0). There was significant decrease in the maximal amplitude (MA) and amplitude (A) in the DIC group, compared with the control group. The OR value (95%CI) of the R reaction time,α-angle and MA was 3.538 (1.298-5.389), 2.472 (1.820-2.224) and 0.256 (0.263-0.831) respectively, which suggests good correlation with the existence of DIC (all P < 0.01). The specificity of R reaction time, α-angle and MA was higher than that of PT, APTT and D-dimers (85.7%, 73.5% and 72.9% vs. 27.0%, 42.1% and 68.2%) . The average R reaction time of children suffering from hemorrhage of severe liver disease(n = 36) was significantly longer than that of 40 healthy children [(9.2 ± 2.7) vs. (2.3 ± 1.8)s, P = 0.001 0], while the α-angle (42.8° ± 7.6° vs. 59.2° ± 10.8°, P = 0.040 0) and the MA value [(33.9 ± 5.1) vs.(56.0 ± 8.1) mm, P = 0.020 0] were significantly smaller. The average R reaction time of children suffering from congenital coagulopathy was significantly longer than that of healthy children [(6.8 ± 3.1) vs. (2.3 ± 1.8)s, P = 0.003 0], too.
  
  
  CONCLUSIONS
  TEM, which has high specificity, is beneficial to the diagnosis of DIC in children.
authors.affiliation: Critical Care Department, Children's Hospital of Fudan University, Shanghai 201102, China.
authors.forename: Yixue
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Critical Care Department, Children's Hospital of Fudan University, Shanghai 201102, China. Email: luxy2005@aliyun.com.
authors.forename: Guoping
authors.initials: G
authors.lastname: Lu
authors.affiliation: Critical Care Department, Children's Hospital of Fudan University, Shanghai 201102, China.
authors.forename: Zhujin
authors.initials: Z
authors.lastname: Lu
authors.affiliation: Critical Care Department, Children's Hospital of Fudan University, Shanghai 201102, China.
authors.forename: Lingen
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Critical Care Department, Children's Hospital of Fudan University, Shanghai 201102, China.
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Feng
mesh_terms: D001777:Blood Coagulation; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000175:diagnosis*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011517:Prothrombin Time; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013916:Thrombelastography
chemical_list: D005338:Fibrin Fibrinogen Degradation Products