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01-11-2021 | Original Article

It is time for TEG in pediatric trauma: unveiling meaningful alterations in children who undergo massive transfusion

Authors: Ryan Phillips, Hunter Moore, Denis Bensard, Niti Shahi, Gabrielle Shirek, Marina L. Reppucci, Maxene Meier, John Recicar, Shannon Acker, John Kim, Steven Moulton

Published in: Pediatric Surgery International | Issue 11/2021

Abstract

Background

Hemorrhage is the leading cause of preventable death in pediatric trauma patients. In adults, goal-directed thrombelastography (TEG) has been shown to reduce mortality when used to guide massive transfusion (MT) resuscitation. There remains a paucity of data on the utility of TEG in directing resuscitation of pediatric trauma patients. We hypothesize that abnormalities on admission TEG will differ in pediatric trauma patients who undergo MT, compared to those who do not.

Methods

Pediatric patients (≤ 18 years) who were highest level trauma activations at two trauma centers from 2015 to 2018 were analyzed. We included patients who had admission TEGs and excluded those who did not. Patients were stratified into two groups: those who received MT (> 40 cc/kg total blood product within 6 h of admission) and those who did not. We defined TEG abnormalities based on each institution’s normative values and compared TEG abnormalities between the groups.

Results

Of 117 children included, 39 had MT. MT patients had higher injury severity scores (30 vs. 23, p = 0.0004), lactates levels (7.0 vs. 3.5, p < 0.001), base deficit levels ( − 12.2 vs. − 5.8, p < 0.001), and INR values (1.8 vs. 1.3, p < 0.001). MT patients had significantly shortened alpha-angles (35.9% vs. 15.4%, p = 0.023), maximum amplitude (MA) values (43.6% vs. 10.3%, p < 0.001), and significantly lower platelet counts (165 vs. 281, p < 0.001) compared to those who did not receive MT. There was no difference in the trends in R-time, LY30 (lysis or shutdown), or fibrinogen concentration between the groups. Logistic regression identified a decreased MA as a significant predictor for MT [OR 3.68 (CI 1.29–10.52)]

Conclusions

Pediatric trauma patients who undergo MT are more likely to have lower alpha-angles and MA values, as well as lower platelet counts. These findings support the use of TEG to identify hemorrhaging pediatric trauma patients, who may benefit from cryoprecipitate and/or platelet transfusions. TEG provides real-time information on coagulation status, which may expedite the delivery of specific blood products during trauma resuscitation.

Level of evidence: Level III

Type of study: Retrospective comparative study.

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Title: It is time for TEG in pediatric trauma: unveiling meaningful alterations in children who undergo massive transfusion
Authors: Ryan Phillips
Hunter Moore
Denis Bensard
Niti Shahi
Gabrielle Shirek
Marina L. Reppucci
Maxene Meier
John Recicar
Shannon Acker
John Kim
Steven Moulton
Publication date: 01-11-2021
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 11/2021
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-021-04944-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

It is time for TEG in pediatric trauma: unveiling meaningful alterations in children who undergo massive transfusion

Abstract

Background

Methods

Results

Conclusions

Level of evidence: Level III

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Level of evidence: Level III

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