Coagulation testing in pediatric blunt trauma patients

Objectives: To determine the prevalence of abnormal coagulation studies and to identify variables associated with markedly elevated coagulation studie s in children with blunt trauma. Methods: We reviewed the medical records of all patients < 15 years old hos pitalized at a Level 1 trauma center for either blunt head or torso trauma over a 4-year period. Data from each patient's emergency department (ED) pr esentation were abstracted. ED coagulation studies were defined prior to da ta analysis as elevated if the international normalized ratio (INR) was <gr eater than or equal to>1.2 or partial thromboplastin time (PTT) was greater than or equal to 33.0 seconds and markedly elevated if the INR was greater than or equal to1.5 or PTT was greater than or equal to 40 seconds. Variab les associated with markedly elevated coagulation studies in a univariate a nalysis (P < 0.05) were entered into a backward elimination logistic regres sion analysis to identify variables independently associated with markedly elevated coagulation studies. Results: A total of 1082 patients' records were reviewed, and the 830 (77%) patients with coagulation studies obtained composed the study population. Elevated coagulation studies were detected in 232 (28%) patients, and 49 (6 %) of these were found to be markedly elevated. In the multivariate analysi s, a GCS <less than or equal to>13 (odds ratio [OR] 8.7, 95% confidence int erval [CI] 4.3,17.7), low systolic blood pressure (OR 4.0,95% CI 1.6,9.9), open/multiple bony fractures (OR 2.9, 95% CI 1.4, 6.2), and major tissue wo unds (OR 2.8, 95% CI 1.4, 5.6) were independently associated with markedly elevated coagulation studies. Conclusion: Hospitalized pediatric blunt trauma patients frequently have mi nor elevations in ED coagulation studies. Marked elevations occur infrequen tly and are independently associated with a GCS less than or equal to 13, l ow systolic blood pressure, open/multiple bony fractures, and major tissue wounds.