Liras Ioannis N, Rahbar Elaheh, Harting Matthew T, Holcomb John B, Cotton Bryan A
From the Departments of Surgery (I.N.L., E.R., J.H., B.A.C.) and Pediatric Surgery (M.T.H.), The Center for Translational Injury Research (J.H., B.A.C.), and The Center for Surgical Trials and Evidence-based Practice (M.T.H., B.A.C.), The University of Texas Medical School at Houston, Houston, Texas.
J Trauma Acute Care Surg. 2016 May;80(5):778-82. doi: 10.1097/TA.0000000000000985.
Thrombelastography (TEG) maximal amplitude (mA) has also been shown to reflect hypercoagulability and increased venous thromboembolism (VTE) risk in adult trauma patients. Based on these previous works, we sought to identify when children become adults with respect to TEG mA values and whether this correlated with VTE risk.
We evaluated all trauma patients admitted from January 2010 to December 2013 who were highest-level activations. Age was evaluated as a continuous variable, followed by a categorical evaluation. TEG mA values were evaluated as continuous and dichotomous (hypercoagulable, mA ≥ 65 mm). Logistic regression was then constructed controlling for age categories, sex, and injury severity to assess the association with TEG mA values and VTE risk.
A total of 7,194 Level 1 trauma patients were admitted during this time frame (819 were <18 years of age). The likelihood of mA equal to or greater than 65 mm remained at 35% to 37% through age 30 years with significant increases observed at ages 31 years to 35 years (45%) and 46 years to 50 years (49%), both p < 0.01. When controlling for injury severity, race, and sex, logistic regression demonstrated that every 5-year increase in age (after age 30 years) was associated with a 16% increased likelihood of hypercoagulability at admission. Beginning with age 1 year, VTE risk remained at 1.5% or less until age 13 years where it increased to 2.3%, increasing again at age 15 years to 5.1%. Two additional significant increases were identified between ages 31 years and 35 years (5.5%) as well as 46 years and 50 years (7.6%), both p < 0.001. Logistic regression demonstrated a 3.4-fold increased risk for VTE among those aged 31 years to 50 years compared with those who are younger than 30 years. The same model noted a 2.3-fold increased risk compared with those who are older than 50 years.
Beginning at age 13 years, children transition toward adult hypercoagulability, as evidenced by elevated TEG mA values and VTE risk. However, the greatest VTE risk (and highest likelihood of hypercoagulable mA) is among those adults 31 years to 50 years of age.
Prognostic and epidemiologic study, level III.
血栓弹力图（TEG）最大振幅（mA）也已被证明可反映成年创伤患者的高凝状态及静脉血栓栓塞（VTE）风险增加。基于这些先前的研究，我们试图确定儿童在TEG mA值方面何时成年，以及这是否与VTE风险相关。
我们评估了2010年1月至2013年12月期间收治的所有最高级别的创伤患者。年龄被评估为连续变量，随后进行分类评估。TEG mA值被评估为连续变量和二分变量（高凝，mA≥65mm）。然后构建逻辑回归模型，控制年龄类别、性别和损伤严重程度，以评估与TEG mA值和VTE风险的关联。
在此时间段内，共收治了7194例一级创伤患者（819例年龄<18岁）。在30岁之前，mA等于或大于65mm的可能性保持在35%至37%，在31岁至35岁（45%）和46岁至50岁（49%）时显著增加，两者p<0.01。在控制损伤严重程度、种族和性别后，逻辑回归表明，年龄每增加5岁（30岁以后），入院时高凝状态的可能性增加16%。从1岁开始，VTE风险在13岁之前保持在1.5%或更低，之后增加到2.3%，在15岁时再次增加到5.1%。在31岁至35岁（5.5%）以及46岁至50岁（7.6%）之间还发现了另外两次显著增加，两者p<0.001。逻辑回归表明，与年龄小于30岁的人相比，31岁至50岁的人发生VTE的风险增加3.4倍。与年龄大于50岁的人相比，同一模型显示风险增加2.3倍。
从13岁开始，儿童向成人高凝状态转变，这通过升高的TEG mA值和VTE风险得以证明。然而，最大的VTE风险（以及高凝mA的最高可能性）出现在31岁至50岁的成年人中。
预后和流行病学研究，三级。
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