title: Trauma induced hypercoagulablity in pediatric patients.
abstract: OBJECTIVE
  Coagulation changes in pediatric trauma patients are not well defined. To fill this gap, we tested the hypothesis that trauma evokes a hypercoagulable response.
  
  
  METHODS
  A prospective observational study was conducted in hospitalized patients (age 8months to 14years) admitted for trauma or elective surgery. Informed consent was obtained from the parents and informed assent was obtained in patients 7years of age or older. Coagulation changes were evaluated on fresh whole blood using thromboelastography (TEG) and on stored plasma using assays for special clotting factors.
  
  
  RESULTS
  Forty three patients (22 trauma, median injury severity score =9; and 21 uninjured controls) were evaluated. For trauma vs control, prothrombin time (PT) was higher by about 10% (p<0.001), but activated partial thromboplastin time was not altered. TEG clotting time (R;p=0.005) and fibrin cross-linking were markedly accelerated (K time, alpha angle; p<0.001) relative to the control patients. d-Dimer, Prothrombin Fragment 1+2, and Plasminogen Activator Inhibitor-1 were all elevated, whereas Protein S activity was reduced (all p<0.01). Importantly, a large fraction of TEG values and clotting factor assays in the pediatric control group were outside the published reference ranges for adults.
  
  
  CONCLUSIONS
  A hypercoagulable state is associated with minor trauma in children. More work is needed to determine the functional significance of these changes and to establish normal pediatric reference ranges.
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Ryan
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Van Haren
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Thorson
authors.affiliation: Department of Pathology, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Andrews
authors.affiliation: Dewitt-Daughtry Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Perez
authors.affiliation: Dewitt-Daughtry Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Neville
authors.affiliation: Dewitt-Daughtry Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Sola
authors.affiliation: Dewitt-Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL 33136, USA. Electronic address: kproctor@miami.edu.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Proctor
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011517:Prothrombin Time; D013916:Thrombelastography; D019851:Thrombophilia / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D014947:Wounds and Injuries / Q000150:complications*
keywords: Coagulation; Pediatric; Thromboelastography; Trauma