Rotational thromboelastometry in children presenting to an Australian major trauma centre: A retrospective cohort study

Loading...
Thumbnail Image
File version

Version of Record (VoR)

Author(s)
George, Shane
Wake, Elizabeth
Sweeny, Amy
Campbell, Don
Winearls, James
Primary Supervisor
Other Supervisors
Editor(s)
Date
2022
Size
File type(s)
Location
Abstract

OBJECTIVE: This retrospective cohort study aims to describe patterns of rotational thromboelastometry (ROTEM™) results in paediatric trauma following the implementation of a ROTEM-guided critical bleeding algorithm and major haemorrhage protocol (MHP). METHODS: This retrospective observational study was conducted in a tertiary trauma hospital in Queensland, Australia, where point-of-care ROTEM was introduced for paediatric patients in 2014. All children aged less than 18 years who had a ROTEM test during their presentation between January 2014 and December 2017 for a traumatic injury were included in the dataset. Other children with a record in the hospital's trauma registry in the same period were also screened for blood product usage. Data were collected for frequency of ROTEM testing, pathology and ROTEM results, blood product and antifibrinolytic use along with injury related data. Compliance with recommended treatment thresholds for detected coagulopathy was also reviewed. RESULTS: A total of 1039 children were listed in the trauma registry, including 167 children having a ROTEM test for trauma. Factors significantly associated with having a ROTEM test were older age, higher injury severity score (ISS >12) and penetrating injury. A result exceeding a treatment threshold was returned for 122 (73.1%) of 167 children, with hyperfibrinolysis identified in 88 (52.6%) of 167 and hypofibrinogenaemia identified in 54 (32.3%) of 167. Adherence with the recommended treatments for those children where a treatment threshold was exceeded was low in this cohort. CONCLUSION: The use of ROTEM-guided blood component replacement is an emerging practice in children for both traumatic and non-traumatic bleeding. Targeted replacement of identified coagulation defects guided by rapid point-of-care testing is an emerging alternative to fixed-ratio-based protocols. Further research is required to validate treatment thresholds in the paediatric population and further investigate the clinical outcomes for patients as a result of early correction of trauma-induced coagulopathy.

Journal Title

Emergency Medicine Australasia

Conference Title
Book Title
Edition
Volume
Issue
Thesis Type
Degree Program
School
Publisher link
Patent number
Funder(s)
Grant identifier(s)
Rights Statement
Rights Statement

© 2022 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Item Access Status
Note
Access the data
Related item(s)
Subject

Paediatrics

Haematology

Emergency medicine

paediatric

trauma

viscoelastic haemostatic assay

Persistent link to this record
Citation

George, S; Wake, E; Sweeny, A; Campbell, D; Winearls, J, Rotational thromboelastometry in children presenting to an Australian major trauma centre: A retrospective cohort study, Emergency Medicine Australasia, 2022

Collections