儿童和青年创伤患者的血浆凝血酶生成动力学因损伤模式和复苏特征而异。
Plasma thrombin generation kinetics vary by injury pattern and resuscitation characteristics in pediatric and young adult trauma patients.
机构信息
From the Division of Trauma, Critical Care, and General Surgery, Department of Surgery (T.A.M., J.G., A.S.H., D.R., M.S.P.), Mayo Clinic, Rochester Minnesota; Division of Acute Care Surgery, Department of Surgery (J.G.), Rutgers Robert Wood Johnson Medical School, 125 Paterson St., New Brunswick, New Jersey; and Division of Pediatric Surgery, Department of Surgery (S.F.P., D.B.K.), Mayo Clinic, Rochester, Minnesota.
出版信息
J Trauma Acute Care Surg. 2023 Sep 1;95(3):307-312. doi: 10.1097/TA.0000000000003901. Epub 2023 Mar 11.
BACKGROUND
Thrombin generation kinetics are not well studied in children. This study aimed to assess how thrombin generation kinetics vary in pediatric and young adult (YA) trauma patients by clinical characteristics and injury pattern.
METHODS
Prospective cohort study where plasma samples were obtained from pediatric (ages 0-17 years) and YA (ages 18-21 years) trauma patients upon emergency department arrival. Thrombin generation (calibrated automated thrombogram [CAT]) was quantified as lag time (LT, minutes), peak height (PH, nM), time to peak (ttPeak, minutes), and endogenous thrombin potential (ETP, nM × minute). Results are expressed as median and quartiles [Q1, Q3] and compared using Wilcoxon rank sum testing with p < 0.05 considered significant.
RESULTS
We enrolled 47 pediatric (median age, 15 [14, 17] years, 78% male, 87% blunt, median Injury Severity Score, 12) and 49 YA (median age 20 [18, 21] years, 67% male, 84% blunt, median Injury Severity Score, 12) patients. Pediatric and YA patients had similar rates of operative intervention (51% vs. 57%), transfusion (25% vs. 20%), and traumatic brain injury (TBI) (53% vs. 49%). Pediatric patients who required an operation had accelerated initiation of thrombin generation, with shorter LT than those who did not (2.58 [2.33, 2.67]; 2.92 [2.54, 3.00], p = 0.034). Shorter LT (2.41 [2.22, 2.67]; 2.67 [2.53, 3.00]) and ttPeak (4.50 [4.23, 4.73]; 5.22 [4.69, 5.75], both p < 0.01) were noted in pediatric patients who required transfusion as compared with those who did not. The YA patients requiring transfusion had shorter LT (2.33 [2.19, 2.74]; 2.83 [2.67, 3.27]) and ttPeak (4.48 [4.33, 5.65]; 5.33 [4.85, 6.28] both p < 0.04) than those who were not transfused. Young adults with TBI had greater ETP than those without (1509 [1356, 1671]; 1284 [1154, 1471], p = 0.032).
CONCLUSION
Thrombin generation kinetics in pediatric trauma patients prior to intervention vary with need for operation and transfusion, while thrombin generation kinetics in young adult patients are influenced by TBI and need for operation or transfusion. This is a promising tool for assessing coagulopathy in young trauma patients.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level III.
背景
目前对于儿童的凝血酶生成动力学研究还不够充分。本研究旨在通过临床特征和损伤模式评估儿科和青年（YA）创伤患者的凝血酶生成动力学如何发生变化。
方法
这是一项前瞻性队列研究，在急诊科到达时从儿科（0-17 岁）和 YA（18-21 岁）创伤患者中采集血浆样本。通过校准自动血栓图（CAT）定量检测凝血酶生成（LT，分钟）、峰值高度（PH，nM）、达峰时间（ttPeak，分钟）和内源性凝血酶潜能（ETP，nM×分钟）。结果表示为中位数和四分位数[Q1、Q3]，并使用 Wilcoxon 秩和检验进行比较，p<0.05 认为差异具有统计学意义。
结果
我们共纳入 47 例儿科（中位年龄 15[14，17]岁，78%为男性，87%为钝器伤，中位损伤严重程度评分 12）和 49 例 YA（中位年龄 20[18，21]岁，67%为男性，84%为钝器伤，中位损伤严重程度评分 12）患者。儿科和 YA 患者的手术干预率（51%比 57%）、输血率（25%比 20%）和创伤性脑损伤（TBI）率（53%比 49%）相似。需要手术的儿科患者凝血酶生成的启动更快，LT 短于未手术患者（2.58[2.33，2.67]；2.92[2.54，3.00]，p=0.034）。与未输血的患者相比，需要输血的儿科患者 LT 更短（2.41[2.22，2.67]；2.67[2.53，3.00]）和 ttPeak 更短（4.50[4.23，4.73]；5.22[4.69，5.75]，均 p<0.01）。需要输血的 YA 患者 LT 更短（2.33[2.19，2.74]；2.83[2.67，3.27]）和 ttPeak 更短（4.48[4.33，5.65]；5.33[4.85，6.28]，均 p<0.04）。与无脑损伤的患者相比，有 TBI 的 YA 患者 ETP 更高（1509[1356，1671]；1284[1154，1471]，p=0.032）。
结论
在接受干预之前，儿科创伤患者的凝血酶生成动力学因手术和输血的需求而异，而 YA 患者的凝血酶生成动力学受 TBI 以及手术或输血的需求影响。这是一种有前途的评估年轻创伤患者凝血障碍的工具。
证据等级
预后和流行病学；III 级。
Zotero 插件