title: Acute coagulopathy in children with multiple trauma: a retrospective study.
abstract: BACKGROUND
  Acute coagulopathy associated with trauma has been recognized for decades and is a constituent of the "triad of death" together with hypothermia and acidosis.
  
  
  OBJECTIVE
  The 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.
  
  
  METHODS
  Ninety-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.
  
  
  RESULTS
  Coagulopathy 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).
  
  
  CONCLUSIONS
  Acute coagulopathy is present on admission to the ED and is associated with injury severity and significantly higher mortality.
authors.affiliation: Department of Pediatric Surgery, University Hospital of Heraklion, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Sakellaris
authors.affiliation: Department of Pediatric Surgery, University Hospital of Heraklion, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Blevrakis
authors.affiliation: Department of General Surgery, University Hospital of Heraklion, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Petrakis
authors.affiliation: Department of Pediatric Surgery, University Hospital of Heraklion, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Dimopoulou
authors.affiliation: Department of Pediatric Surgery, University Hospital of Heraklion, Greece.
authors.forename: Olga
authors.initials: O
authors.lastname: Dede
authors.affiliation: Department of Pediatric Surgery, University Hospital of Heraklion, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Partalis
authors.affiliation: Department of Biostatistics, University of Crete, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Alegakis
authors.affiliation: Department of Pediatric Surgery, University Hospital of Heraklion, Greece.
authors.forename: Chrysa
authors.initials: C
authors.lastname: Seremeti
authors.affiliation: Pediatric Intensive Care Unit, University Hospital of Herakion, Greece.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Spanaki
authors.affiliation: Pediatric Intensive Care Unit, University Hospital of Herakion, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Briassoulis
mesh_terms: D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D004906:Erythrocyte Count; D005260:Female; D015600:Glasgow Coma Scale; D006454:Hemoglobins / Q000378:metabolism; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D015278:Intensive Care Units, Pediatric; D019934:International Normalized Ratio; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology; D009104:Multiple Trauma / Q000150:complications* / Q000401:mortality; D063305:Organ Dysfunction Scores; D010314:Partial Thromboplastin Time; D010343:Patient Admission; D010976:Platelet Count; D011517:Prothrombin Time; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D006454:Hemoglobins
keywords: ISS; SOFA; coagulopathy; trauma