Prothrombin Time ratio can predict mortality in severe pediatric trauma: Study in a French trauma center level 1

Injury results in more deaths in children than all other causes combined, but there is little data regarding the association of early coagulopathy on outcomes in pediatric patients with traumatic injuries. The aim of this study was to determine the optimal cut-off value for the Prothrombin Time rati...

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Published in:The American journal of emergency medicine 2020-10, Vol.38 (10), p.2041-2044
Main Authors: Hochart, Audrey, Momal, Romain, Garrigue-Huet, Delphine, Drumez, Elodie, Susen, Sophie, Bijok, Benjamin
Format: Article
Language:English
Subjects:
Adolescent
Child
Child, Preschool
Children
Coagulopathy
Embolization
Emergency medical care
Female
France - epidemiology
Hemorrhagic shock
Hospitalization
Humans
Infant
Injuries
Laboratories
Life Sciences
Male
Mortality
Mortality - trends
Patients
Pediatric
Pediatrics
Pediatrics - instrumentation
Pediatrics - methods
Pediatrics - trends
Population
Predictive Value of Tests
Probability
Prothrombin
Prothrombin Time - methods
Prothrombin Time - statistics & numerical data
Prothrombin Time ratio
Retrospective Studies
Surgery
Thorax
Trauma
Trauma centers
Trauma Centers - organization & administration
Trauma Centers - statistics & numerical data
Vehicles
Wounds and Injuries - blood
Wounds and Injuries - complications
Wounds and Injuries - mortality
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description Injury results in more deaths in children than all other causes combined, but there is little data regarding the association of early coagulopathy on outcomes in pediatric patients with traumatic injuries. The aim of this study was to determine the optimal cut-off value for the Prothrombin Time ratio (PTr) and to show the diagnostic characteristics of the PTr to predict mortality. We retrospectively included during 4 years all patients less than 16 years old referred to our trauma center for traumatic injury with ISS ≥9. A total of 272 children were included. Mean age was 9.4 ± 4.8 years and median ISS was 17 [interquartile range, 12 to 26]. Day 28 mortality was 6.7%. The optimal cut-off value in our population for predicting day 28 mortality was 1.24. Using this value, the sensitivity of PTr was 84%, specificity was 82%, positive likelihood ratio was 4.7, and negative likelihood ratio was 0.19. Early mortality (i.e., mortality at 24 h) was also well-predicted (1.0% versus 16.4%, p 
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The aim of this study was to determine the optimal cut-off value for the Prothrombin Time ratio (PTr) and to show the diagnostic characteristics of the PTr to predict mortality. We retrospectively included during 4 years all patients less than 16 years old referred to our trauma center for traumatic injury with ISS ≥9. A total of 272 children were included. Mean age was 9.4 ± 4.8 years and median ISS was 17 [interquartile range, 12 to 26]. Day 28 mortality was 6.7%. The optimal cut-off value in our population for predicting day 28 mortality was 1.24. Using this value, the sensitivity of PTr was 84%, specificity was 82%, positive likelihood ratio was 4.7, and negative likelihood ratio was 0.19. Early mortality (i.e., mortality at 24 h) was also well-predicted (1.0% versus 16.4%, p &lt; .0001), as the need for massive transfuion. 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Trauma-induced coagulopathy defined only by a PTr ≥1.24 could be used as a severity predictive marker and as a sensitive, specific, quick, and easy to use tool for admission triage of pediatric patients. •Among 272 children with trauma injury, an admission PTr ≥1.24 was determined as a significant value to predict mortality.•Mortality at 24 h was well predictable using a cutoff of PTr ≥1.24 (1.0% versus 16.4%, p &lt; .0001).•An early diagnosis of acute trauma-induced coagulopathy could be useful for admission triage of pediatric patients.</description><identifier>ISSN: 0735-6757</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2020.06.075</identifier><identifier>PMID: 33142171</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Child ; Child, Preschool ; Children ; Coagulopathy ; Embolization ; Emergency medical care ; Female ; France - epidemiology ; Hemorrhagic shock ; Hospitalization ; Humans ; Infant ; Injuries ; Laboratories ; Life Sciences ; Male ; Mortality ; Mortality - trends ; Patients ; Pediatric ; Pediatrics ; Pediatrics - instrumentation ; Pediatrics - methods ; Pediatrics - trends ; Population ; Predictive Value of Tests ; Probability ; Prothrombin ; Prothrombin Time - methods ; Prothrombin Time - statistics &amp; numerical data ; Prothrombin Time ratio ; Retrospective Studies ; Surgery ; Thorax ; Trauma ; Trauma centers ; Trauma Centers - organization &amp; administration ; Trauma Centers - statistics &amp; numerical data ; Vehicles ; Wounds and Injuries - blood ; Wounds and Injuries - complications ; Wounds and Injuries - mortality</subject><ispartof>The American journal of emergency medicine, 2020-10, Vol.38 (10), p.2041-2044</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. 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ispartof The American journal of emergency medicine, 2020-10, Vol.38 (10), p.2041-2044
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subjects Adolescent
Child
Child, Preschool
Children
Coagulopathy
Embolization
Emergency medical care
Female
France - epidemiology
Hemorrhagic shock
Hospitalization
Humans
Infant
Injuries
Laboratories
Life Sciences
Male
Mortality
Mortality - trends
Patients
Pediatric
Pediatrics
Pediatrics - instrumentation
Pediatrics - methods
Pediatrics - trends
Population
Predictive Value of Tests
Probability
Prothrombin
Prothrombin Time - methods
Prothrombin Time - statistics & numerical data
Prothrombin Time ratio
Retrospective Studies
Surgery
Thorax
Trauma
Trauma centers
Trauma Centers - organization & administration
Trauma Centers - statistics & numerical data
Vehicles
Wounds and Injuries - blood
Wounds and Injuries - complications
Wounds and Injuries - mortality
title Prothrombin Time ratio can predict mortality in severe pediatric trauma: Study in a French trauma center level 1
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