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Plasma Thrombin Generation Kinetics Vary by Injury Pattern and Resuscitation Characteristics in Pediatric and Young Adult Trauma Patients.
Journal of Trauma and Acute Care Surgery 2023 March 12
BACKGROUND: Thrombin generation kinetics are not well studied in children. This study aimed to assess how thrombin generation kinetics vary in pediatric and young adult (YA) trauma patients by clinical characteristics and injury pattern.
METHODS: Prospective cohort study where plasma samples were obtained from pediatric (ages 0-17) and YA (ages 18-21) trauma patients upon Emergency Department arrival. Thrombin generation (Calibrated Automated Thrombogram, CAT) was quantified as lag time (LT, minutes), peak height (PH, nM), time to peak (ttPeak, minutes), and endogenous thrombin potential (ETP, nm*minute). Results are expressed as median and quartiles [Q1, Q3] and compared using Wilcoxon rank sum testing with p < 0.05 considered significant.
RESULTS: We enrolled 47 pediatric (median age 15 [14, 17] years, 78% male, 87% blunt, median ISS 12) and 49 YA (median age 20 [18, 21] years, 67% male, 84% blunt, median ISS 12) patients. Pediatric and YA patients had similar rates of operative intervention (51% vs. 57%), transfusion (25% vs. 20%), and TBI (53% vs. 49%). Pediatric patients who required an operation had accelerated initiation of thrombin generation, with shorter LT than those who did not (2.58 [2.33, 2.67]; 2.92 [2.54, 3.00], p = 0.034). Shorter LT (2.41 [2.22, 2.67]; 2.67 [2.53, 3.00]) and ttPeak (4.50 [4.23, 4.73]; 5.22 [4.69, 5.75], both p < 0.01) were noted in pediatric patients who required transfusion as compared to those who did not. YA patients requiring transfusion had shorter LT (2.33 [2.19, 2.74]; 2.83 [2.67, 3.27]) and ttPeak (4.48 [4.33, 5.65]; 5.33 [4.85, 6.28] both p < 0.04) than those who were not transfused. YAs with traumatic brain injury had greater ETP than those without (1509 [1356, 1671]; 1284 [1154, 1471], p = 0.032).
CONCLUSIONS: Thrombin generation kinetics in pediatric trauma patients prior to intervention vary with need for operation and transfusion, while thrombin generation kinetics in young adult patients are influenced by TBI and need for operation or transfusion. This is a promising tool for assessing coagulopathy in young trauma patients.
LEVEL OF EVIDENCE: Level IV, Prognostic/epidemiological.
METHODS: Prospective cohort study where plasma samples were obtained from pediatric (ages 0-17) and YA (ages 18-21) trauma patients upon Emergency Department arrival. Thrombin generation (Calibrated Automated Thrombogram, CAT) was quantified as lag time (LT, minutes), peak height (PH, nM), time to peak (ttPeak, minutes), and endogenous thrombin potential (ETP, nm*minute). Results are expressed as median and quartiles [Q1, Q3] and compared using Wilcoxon rank sum testing with p < 0.05 considered significant.
RESULTS: We enrolled 47 pediatric (median age 15 [14, 17] years, 78% male, 87% blunt, median ISS 12) and 49 YA (median age 20 [18, 21] years, 67% male, 84% blunt, median ISS 12) patients. Pediatric and YA patients had similar rates of operative intervention (51% vs. 57%), transfusion (25% vs. 20%), and TBI (53% vs. 49%). Pediatric patients who required an operation had accelerated initiation of thrombin generation, with shorter LT than those who did not (2.58 [2.33, 2.67]; 2.92 [2.54, 3.00], p = 0.034). Shorter LT (2.41 [2.22, 2.67]; 2.67 [2.53, 3.00]) and ttPeak (4.50 [4.23, 4.73]; 5.22 [4.69, 5.75], both p < 0.01) were noted in pediatric patients who required transfusion as compared to those who did not. YA patients requiring transfusion had shorter LT (2.33 [2.19, 2.74]; 2.83 [2.67, 3.27]) and ttPeak (4.48 [4.33, 5.65]; 5.33 [4.85, 6.28] both p < 0.04) than those who were not transfused. YAs with traumatic brain injury had greater ETP than those without (1509 [1356, 1671]; 1284 [1154, 1471], p = 0.032).
CONCLUSIONS: Thrombin generation kinetics in pediatric trauma patients prior to intervention vary with need for operation and transfusion, while thrombin generation kinetics in young adult patients are influenced by TBI and need for operation or transfusion. This is a promising tool for assessing coagulopathy in young trauma patients.
LEVEL OF EVIDENCE: Level IV, Prognostic/epidemiological.
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