From the Emergency Department, Schneider Children Medical Center.
Trauma Service, Rabin Medical Center-Beilinson Hospital, Petakh Tikva.
Pediatr Emerg Care. 2022 Oct 1;38(10):e1637-e1640. doi: 10.1097/PEC.0000000000002719. Epub 2022 Apr 12.
Early hypocalcemia (EH) is common in adult major trauma patients and has been associated with coagulopathy, shock, increased transfusion requirements, and mortality. The incidence of EH in pediatric severe trauma has not been investigated. We aimed to explore the incidence of EH among severely injured children.
We conducted a retrospective cohort study at a tertiary children's hospital and a level 1 pediatric trauma center. We extracted the medical records of all pediatric major trauma patients, defined as an age less than 18 years and an Injury Severity Score (ISS) greater than 15, admitted after trauma team activation from January 2010 to December 2020.The primary outcome was the presence of EH. Patients were classified into 3 groups: severe hypocalcemia (ionized calcium [iCa] <1 mmol/L), hypocalcemia (1 < iCa < 1.16 mmol/L), and normal calcium (iCa ≥1.16 mmol/L).
During the study period, 5126 children were hospitalized because of trauma. One hundred eleven children met the inclusion criteria. The median age was 11 years (interquartile range [IQR], 4-15), and 78.4% (87) were male. The median ISS was 21 (IQR, 17-27).Hypocalcemia was found in 19.8% (22) and severe hypocalcemia in 2.7% (3) of the patients.Although not statistically significant, hypocalcemic pediatric trauma patients had higher ISS (25.5 [IQR, 17-29] vs 21 [IQR, 17-26], P = 0.39), lower Glasgow Coma Scale (11 [IQR, 3-15] vs 13 [IQR, 7-15], P = 0.24), a more prolonged hospital stay (8 days [IQR, 2-16] vs 6 days [IQR, 3-13], P = 0.36), a more frequent need for blood products (27.3% vs 20.2%, P = 0.74), and higher mortality rates (9.1% vs 1.1%, P = 0.18) compared with normocalcemic patients.
Our data suggest that in the setting of major trauma, EH is less frequent in children than previously reported in adults. Our preliminary data suggest that pediatric patients with EH may be at risk of increased morbidity and mortality compared with children with normal admission iCa requiring further studies.
成人严重创伤患者中早期低钙血症（EH）较为常见，且与凝血障碍、休克、需要大量输血和死亡率增加有关。EH 在儿科严重创伤患者中的发生率尚未得到研究。本研究旨在探讨严重创伤患儿 EH 的发生率。
我们在一家三级儿童医院和一家 1 级儿科创伤中心进行了一项回顾性队列研究。我们提取了 2010 年 1 月至 2020 年 12 月因创伤团队激活后入院的所有年龄小于 18 岁、损伤严重程度评分（ISS）大于 15 的儿科严重创伤患者的病历。主要结局为 EH 的存在。患者分为 3 组：严重低钙血症（离子钙[iCa]＜1mmol/L）、低钙血症（1＜iCa＜1.16mmol/L）和正常钙（iCa≥1.16mmol/L）。
在研究期间，5126 名儿童因创伤住院。111 名儿童符合纳入标准。中位年龄为 11 岁（四分位距[IQR]，4-15），78.4%（87 名）为男性。ISS 中位数为 21（IQR，17-27）。19.8%（22 名）的患儿存在低钙血症，2.7%（3 名）的患儿存在严重低钙血症。尽管无统计学意义，但低钙血症患儿的 ISS 更高（25.5[IQR，17-29]vs 21[IQR，17-26]，P=0.39），格拉斯哥昏迷量表评分更低（11[IQR，3-15]vs 13[IQR，7-15]，P=0.24），住院时间更长（8 天[IQR，2-16]vs 6 天[IQR，3-13]，P=0.36），更频繁地需要输血制品（27.3%vs 20.2%，P=0.74），死亡率更高（9.1%vs 1.1%，P=0.18）。
我们的数据表明，在严重创伤的情况下，EH 在儿童中的发生率低于以前在成人中报道的发生率。我们的初步数据表明，与血钙正常的患儿相比，EH 患儿可能有更高的发病率和死亡率，需要进一步研究。
