Treatment With Oral Versus Intravenous Acetaminophen in Elderly Trauma Patients With Rib Fractures: A Prospective Randomized Trial

Background Rib fractures are common injuries among traumatically injured patients, and elderly patients with rib fractures are at increased risk for adverse events and death. The purpose of this study was to determine if oral Per os (PO) acetaminophen is as effective as intravenous (IV) acetaminophen in treating the pain associated with rib fractures. Methods We performed a single-center, randomized, placebo-controlled, double-blinded study. Trauma patients who were ≥65 years old and had ≥1 rib fracture were included in this study. Patients were randomized into IV acetaminophen and oral placebo (n = 63) or IV placebo and oral solution acetaminophen (n = 75) groups. The primary outcome was a mean reduction in pain score at 24 hours, and secondary outcomes included opioid use, intensive care unit (ICU) length of stay (LOS), hospital LOS, hospital mortality, the difference in incentive spirometry, and development of pneumonia. Results Among the 138 patients included, there was no statistically significant difference between the 2 study groups in a mean reduction in pain score at 24 hours after injury (PO: 3.24, IV: 2.49; P = .230). Opioid pain medication use was equivalent between groups ( P = .212), and there was no significant difference in hospital mortality rate between groups ( P = .827). There was no statistically significant difference in ICU LOS, hospital LOS, or development of pneumonia. Discussion In elderly trauma patients (age ≥65 years) with 1 or more rib fractures, PO acetaminophen is equivalent to IV acetaminophen for pain control, with no difference in morbidity or mortality. Oral acetaminophen should be preferentially used over IV acetaminophen when treating the elderly trauma patient with rib fractures.

Download Full-text

Efficacy of the Treatment of Elderly Trauma Patients Requiring Intensive Care

Emergency Medicine International ◽

10.1155/2018/2137658 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Kiyohiro Oshima ◽

Masato Murata ◽

Makoto Aoki ◽

Jun Nakajima ◽

Yusuke Sawada ◽

...

Keyword(s):

Intensive Care ◽

Hospital Mortality ◽

Injury Severity ◽

The Elderly ◽

Treatment Costs ◽

Trauma Patients ◽

Icu Stay ◽

Significant Difference ◽

Total Treatment ◽

Elderly Trauma Patients

Purpose. To evaluate the effectiveness of intensive care for the elderly trauma patients aged 80 years and older. Methods. Trauma patients admitted to the intensive care unit (ICU) through the emergency room (ER) at our hospital between January 2013 and December 2016 were analyzed. Patients were divided into two groups: patients aged 80 and older (group E) and <80 years old (group Y). Clinical courses and the total treatment costs were compared between the two groups. Data are shown as median (interquartile range). Results. A hundred and seven trauma patients were included in the study. There were 26 patients in group E and 81 patients in group Y. There was no significant difference in Injury Severity Score (ISS) (group E, 19 (13, 32); group Y, 17 (14, 25); p=0.708); however, the probability of survival (Ps) was significantly lower in group E (group E, 0.895 (0.757, 0.950); group Y, 0.955 (0.878, 0.986); p=0.004). The duration of ICU stay (days) was significantly longer in group E (10 (5, 23)) than in group Y (4 (3, 9); p=0.001), and the total hospital stay (days) was longer in group E (33 (13, 57)) than in group Y (22 (12, 42); p=0.179). The hospital mortality was higher in group E (11.5%) than in group Y (6.2%) without a significant difference (p=0.365). The total treatment costs were significantly higher in group E ($23,558 (12,456, 42,790) with $1 = ¥110.57) than in group Y ($16,538 (7,412, 25,422); p=0.023). Conclusions. Elderly trauma patients require longer-term treatment including ICU stay and greater cost with higher hospital mortality compared with young trauma patients.

Download Full-text

Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000534 ◽

2021 ◽

pp. svn-2020-000534

Author(s):

Zhentang Cao ◽

Xinmin Liu ◽

Zixiao Li ◽

Hongqiu Gu ◽

Yingyu Jiang ◽

...

Keyword(s):

Body Mass Index ◽

Hospital Mortality ◽

Body Mass ◽

Intracerebral Haemorrhage ◽

Final Analysis ◽

Normal Weight ◽

Discharge Disposition ◽

Increased Risk ◽

Significant Difference ◽

Stroke Center

Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of body mass index (BMI) with in-hospital mortality, complications and discharge disposition in ICH.MethodsData were from 85 705 ICH enrolled in the China Stroke Center Alliance study. Patients were divided into four groups: underweight, normal weight, overweight and obese according to Asian-Pacific criteria. The primary outcome was in-hospital mortality. The secondary outcomes included non-routine discharge disposition and in-hospital complications. Discharge to graded II or III hospital, community hospital or rehabilitation facilities was considered non-routine disposition. Multivariable logistic regression analysed association of BMI with outcomes.Results82 789 patients with ICH were included in the final analysis. Underweight (OR=2.057, 95% CI 1.193 to 3.550) patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates, but no significant difference was observed for patients who were overweight or obese. No significant association was found between BMI and non-disposition. Underweight was associated with increased odds of several complications, including pneumonia (OR 1.343, 95% CI 1.138 to 1.584), poor swallow function (OR 1.351, 95% CI 1.122 to 1.628) and urinary tract infection (OR 1.532, 95% CI 1.064 to 2.204). Moreover, obese patients had higher odds of haematoma expansion (OR 1.326, 95% CI 1.168 to 1.504), deep vein thrombosis (OR 1.506, 95% CI 1.165 to 1.947) and gastrointestinal bleeding (OR 1.257, 95% CI 1.027 to 1.539).ConclusionsIn patients with ICH, being underweight was associated with increased in-hospital mortality. Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

Download Full-text

Outcomes of major trauma among patients with chronic kidney disease and receiving dialysis in Nova Scotia: a retrospective analysis

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000672 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000672

Author(s):

Ryan Pratt ◽

Mete Erdogan ◽

Robert Green ◽

David Clark ◽

Amanda Vinson ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Nova Scotia ◽

Kidney Disease ◽

Hospital Mortality ◽

Major Trauma ◽

Injury Severity ◽

Cox Regression ◽

Trauma Patients ◽

Risk Of Death ◽

Increased Risk

BackgroundThe risk of death and complications after major trauma in patients with chronic kidney disease (CKD) is higher than in the general population, but whether this association holds true among Canadian trauma patients is unknown.ObjectivesTo characterize patients with CKD/receiving dialysis within a regional major trauma cohort and compare their outcomes with patients without CKD.MethodsAll major traumas requiring hospitalization between 2006 and 2017 were identified from a provincial trauma registry in Nova Scotia, Canada. Trauma patients with stage ≥3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) or receiving dialysis were identified by cross-referencing two regional databases for nephrology clinics and dialysis treatments. The primary outcome was in-hospital mortality; secondary outcomes included hospital/intensive care unit (ICU) length of stay (LOS) and ventilator-days. Cox regression was used to adjust for the effects of patient characteristics on in-hospital mortality.ResultsIn total, 6237 trauma patients were identified, of whom 4997 lived within the regional nephrology catchment area. CKD/dialysis trauma patients (n=101; 28 on dialysis) were older than patients without CKD (n=4896), with higher rates of hypertension, diabetes, and cardiovascular disease, and had increased risk of in-hospital mortality (31% vs 11%, p<0.001). No differences were observed in injury severity, ICU LOS, or ventilator-days. After adjustment for age, sex, and injury severity, the HR for in-hospital mortality was 1.90 (95% CI 1.33 to 2.70) for CKD/dialysis compared with patients without CKD.ConclusionIndependent of injury severity, patients without CKD/dialysis have significantly increased risk of in-hospital mortality after major trauma.

Download Full-text

THE ROLE OF INTERLEUKIN 1β GENE POLYMORPHISM IN DEVELOPMENT OF PREDOMINANTY SENSORY CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY

Medical Immunology (Russia) ◽

10.15789/1563-0625-2019-1-141-148 ◽

2019 ◽

Vol 21 (1) ◽

pp. 141-148

Author(s):

T. E. Popova ◽

N. A. Shnayder ◽

M. M. Petrova ◽

A. A. Tappakhov

Keyword(s):

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Study Groups ◽

Krasnoyarsk Region ◽

Genotype Frequencies ◽

Increased Risk ◽

Significant Difference ◽

Risk Of Disease ◽

T Locus ◽

Il1b Gene

The aim of the present study was a search for associations between the polymorphic allelic variants 3954 C>T (rs1143644) and -511C>T (rs16944) of IL1B gene in the patients with sensory predominant chronic inflammatory demyelinating polyneuropathies (SP-CIDP) from Krasnoyarsk Region and the Sakha (Yakutia) Republic. A total of 95 people were examined, having been divided into 2 groups according to their residence. The first group consisted of 42 patients living in the Sakha (Yakutia) Republic. The second group included 53 patients living in the Krasnoyarsk Region. It was revealed that the carriers of homozygous CC genotype in the 3954C>T locus were more often detected in patients from the Sakha (Yakutia) Republic, and the carriage of TT genotype is found exclusively in the patients from Krasnoyarsk Region. When comparing the different genotype frequencies in the -511CT locus, we did not reveal any statistically significant differences between the two groups of patients. Presence of the CC genotype of the 3954C>T locus was associated with a significantly increased risk of disease in the patients from Sakha (Yakutia) Republic, while carrying CT and TT genotypes at the locus 3954C>T and the TT genotype at the locus -511C>T, is associated with increased risk disorder among patients of the Krasnoyarsk Region. The frequency of carriage of various genotypes in the 3954C>T and -511C>T loci of the IL1B gene was prevalent among the patients from the Sakha (Yakutia) Republic, the association of genotypes of CC/CT prevailed in patients from the Krasnoyarsk Region (p = 0.005), as well as prevalence of CC/CC and CC/CT (p = 0.023). However, there was no statistically significant difference in occurrence of individual genotypes between the two study groups. When analyzing the carrier frequency of high-producing alleles of 3954C and -511C in patients with SP-CIDP, it was shown that they were significantly more common among patients from the Sakha (Yakutia) Republic and patients from the Krasnoyarsk Region than the low-producing 3954T and -511T alleles. Moreover, the 3954C allele was more often found in the Yakut group (p = 0.001), and in the -511C allele for the Krasnoyarsk group of patients (p = 0.05). The presence of 3954C and -511C alleles increases the risk of SP-CIDP development in patients from the Sakha (Yakutia) Republic, as well as carriage of 3954T allele in patients from the Krasnoyarsk Region.

Download Full-text

Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-18.4.269 ◽

2013 ◽

Vol 18 (4) ◽

pp. 269-276 ◽

Cited By ~ 3

Author(s):

Marianne R. Whittaker

Keyword(s):

Clinical Trials ◽

Adverse Effects ◽

Respiratory Depression ◽

Pediatric Patients ◽

Pediatric Population ◽

Opioid Use ◽

Randomized Controlled ◽

Randomized Controlled Studies ◽

Increased Risk ◽

Significant Difference

BACKGROUND Pediatric patients may be at an increased risk of adverse effects from various medications. Recently, there have been a number of serious adverse events, including several pediatric patients experiencing severe respiratory depression and death as a result of the use of codeine for pain control following tonsillectomy and adenoidectomy. OBJECTIVE To assess the safety of opioid agonists in pediatric patients undergoing operative procedures or have experienced trauma and to evaluate the risk of respiratory depression and death among this population. METHODS PubMed and Medline were searched to identify randomized controlled studies from 1994 to 2012 addressing postsurgery/trauma opioid use in pediatric patients. Relative risks and confidence intervals (CIs) were calculated using data available in clinical trials. RESULTS A total of 16 clinical trials were evaluated for this review. Randomized controlled trials included studies comparing opioids versus non-opioids for a variety of painful conditions. The relative risk of respiratory depression associated with opioid use in 1 trial was 1.63 (95% CI: 0.64–6.13). The remaining 15 trials reviewed described no significant difference in respiratory depression or adverse effects associated with treatment. No deaths were attributed to opioid use in any of these studies. CONCLUSION Opioid-associated respiratory depression was very rare and no deaths were reported in the reviewed studies. These findings under the well-defined conditions of controlled studies may not be the best means of determining overall opioid-associated side effects in pediatric patients.

Download Full-text

Abstract 17292: Does Morbid Obesity Worsens Outcomes in COVID-19?

Circulation ◽

10.1161/circ.142.suppl_3.17292 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sohaib Roomi ◽

Waqas Ullah ◽

Nayab Nadeem ◽

Rehan Saeed ◽

Donald Haas ◽

...

Keyword(s):

Morbid Obesity ◽

Mechanical Ventilation ◽

Hospital Mortality ◽

Invasive Mechanical Ventilation ◽

Multivariate Logistic Regression Analysis ◽

Odds Ratios ◽

Increased Risk ◽

Significant Difference ◽

The Mean ◽

Mean Differences

Introduction: Given the high prevalence of obesity around the globe, patients with coronavirus disease 2019 (COVID-19) are at an increased risk of devastating complications. Hypothesis: We hypothesize that morbid obesity is independently associated with increased risk of in-hospital mortality, upgrade to intensive care unit, invasive mechanical ventilation(IVM), and acute renal failure necessitating dialysis. Methods: A retrospective cohort study was performed to determine the association of basal metabolic index (BMI) with the above-mentioned outcomes. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results: A total of 176 patients with confirmed COVID-19 diagnosis were included. The mean age was 62.2 years, with 51% of male patients. The mean BMI for non-surviving patients was significantly higher compared to patients surviving on the 7th day of hospitalization (35 vs. 30 kg/m2, p=0.022) and patients with a higher BMI had higher in-hospital mortality (21% vs. 9%, OR 3.2, 95% CI 1.3-8.2, p=0.01) compared to patients with a normal BMI. Similarly, patients requiring IMV had a higher BMI (33 vs. 29, p=0.002) compared to non-intubated patients. aOR of patients needing IMV (56% vs. 28%, OR 3.3, 95% CI 1.6-7.0, p=0.002) and upgrade to ICU (46% vs. 28%, OR 2.2, 1.07-4.6, p=0.04) were significantly higher compared to patients with a lower BMI. There was no significant difference between the two groups in terms of the need for dialysis (5% vs. 13%, OR 3.8, 13% vs. 4%, 1.1-14.1, p=0.07). Adjusted odds ratios controlled for baseline comorbidities and medications mirrored the overall results, except for the need to upgrade to ICU. Conclusions: In patients with confirmed COVID-19, morbid obesity serves as an independent risk factor of high in-hospital mortality and the need for invasive mechanical ventilation.

Download Full-text

Comparative Analysis of Intestinal Helminth Infections in Colic and Non-Colic Control Equine Patients

Animals ◽

10.3390/ani10101916 ◽

2020 ◽

Vol 10 (10) ◽

pp. 1916 ◽

Cited By ~ 1

Author(s):

Heidrun Gehlen ◽

Nadine Wulke ◽

Antonia Ertelt ◽

Martin K. Nielsen ◽

Simone Morelli ◽

...

Keyword(s):

Helminth Infection ◽

Scientific Evidence ◽

Age Groups ◽

Study Groups ◽

Control Measures ◽

Anthelmintic Treatment ◽

Intestinal Helminth ◽

Intestinal Helminths ◽

Increased Risk ◽

Significant Difference

All around the world, intestinal helminths constitute one of the most prevalent life-long occurring infections and re-infections affecting all horse age groups. A range of parasite species among strongyles, ascarids, and tapeworms is known to have the potential to cause colic in horses. However, there is a lack of current scientific evidence on the actual relevance of helminth infection levels in the context of colic in horses kept during prevailing epidemiological conditions. Thus, a prospective case-control study on the occurrence of intestinal helminths in a total of 620 mainly adult equine clinic patients was conducted to investigate the association between colic and helminth infection. For each horse, a range of copromicroscopic, serological, and clinical data was obtained, in addition to a questionnaire on relevant anamnestic data, including previous anthelmintic treatment and husbandry. Using a FLOTAC-based copromicroscopic diagnosis, the highest infection rates were seen for strongyles (41.8%), followed by Anoplocephala perfoliata and Parascaris spp. (both 0.8%), with no significant difference between the two study groups. Employing a real-time PCR a 1.1% S. vulgaris DNA prevalence was found. Considerably higher seroprevalences were observed using S. vulgaris and A. perfoliata ELISAs, with 32.3% and 10.7%, respectively. It was noteworthy that no association concerning either serologic status was encountered with colic status. The shedding of strongyle eggs was associated with a 1.8-times increased risk of S. vulgaris seropositivity. Recent anthelmintic treatment was associated with the onset of colic, as animals who had received an anthelmintic during the previous week had a 2.4-times higher risk of signs of colic compared to those who had been treated at least eight weeks prior. Another noteworthy observation was that ponies were significantly less often affected by colic than warmbloods. The high S. vulgaris and considerable A. perfoliata seroprevalences encountered in this investigation should prompt veterinarians, farm managers, and horse owners to maintain consequent and effective worm control measures.

Download Full-text

Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-101119 ◽

2020 ◽

Vol 45 (5) ◽

pp. 351-356 ◽

Cited By ~ 3

Author(s):

Laura Beard ◽

Carl Hillermann ◽

Emma Beard ◽

Sue Millerchip ◽

Rajneesh Sachdeva ◽

...

Keyword(s):

Hospital Mortality ◽

Negative Binomial ◽

Rib Fractures ◽

Serratus Anterior ◽

Regional Analgesia ◽

Cross Sectional ◽

Thoracic Epidural ◽

Pain Scores ◽

Significant Difference ◽

Anterior Plane

BackgroundThere is a paucity of data comparing effectiveness of various techniques for pain management of traumatic rib fractures. This study compared the quality of analgesia provided by serratus anterior plane (SAP) catheters against thoracic epidural (TEA) or paravertebral catheters (PA) in patients with multiple traumatic rib fractures (MRFs).Methods354 patients who received either SAP, TEA or PA at two tertiary referral major trauma centers in the UK were included (2016–2018). Primary outcome were change in inspiratory volumes and pain scores. Secondary outcomes included in-hospital mortality, along with the length of stay in hospital and critical care. Data were analyzed using linear, log-binomial and negative binomial regression models.Main resultsAcross all blocks, there was a mean (SD) increase in inspiratory volume postblock of 789.4 mL (479.7). Ninety-eight per cent of all participants reported moderate/severe pain prior to regional analgesia, which was reduced to 34% postblock. There was no significant difference in the change in inspiratory volume or pain scores between the TEA, PA or SAP groups. Overall crude mortality was 13.2% (95% CI 7.8% to 18.7%). In an adjusted analysis and compared with TEA, in-hospital mortality was similar between groups (relative risk (RR) 0.4, 95% CI 0.1 to 1.0) and (RR 0.5, 95% CI 0.2 to 1.6) for SAP and PA, respectively.ConclusionSAP, TEA and PA all appear to offer the ability to reduce pain scores and improve respiratory function.

Download Full-text

Exposure To ABO Compatible But Non-Group Identical Blood and In-Hospital Mortality

Blood ◽

10.1182/blood.v122.21.3651.3651 ◽

2013 ◽

Vol 122 (21) ◽

pp. 3651-3651

Author(s):

Richard J Cook ◽

Nancy Heddle ◽

Ker-Ai Lee ◽

Yang Liu ◽

Rebecca Barty, MLT ◽

...

Keyword(s):

Hospital Mortality ◽

Research Funding ◽

Cox Regression ◽

Type A ◽

Blood Type ◽

Hospital Death ◽

Trauma Patients ◽

Factors Associated ◽

Blood Types ◽

Increased Risk

Abstract Background Transfusions that are ABO compatible but not group identical (mismatched) are given for a variety of reasons including inventory availability, avoiding wastage from outdating, and clinical urgency. A recent observation at our centre suggested that patient outcome was different for those patients that received a transfusion of units with a compatible but mismatched ABO group compared to those receiving ABO group identical blood. Hence, we performed a retrospective hospital registry study to explore the association between mismatched blood and in-hospital mortality in transfused patients. Study Design Our patient/blood utilization database included 35,487 transfused hospitalized patients from 3 acute care academic centres from April 1, 2002 to October 31, 2011. Information on transfused RBCs included duration of storage (days) and ABO type. Patient data included: sex; age; hemoglobin; creatinine; diagnosis; interventions; ABO blood group and hospital discharge status. Factors associated with mismatched blood and in-hospital mortality were examined using generalized estimating equations to account for the potential serial dependence over multiple transfusions. The effect of exposure to ABO mismatched blood on in-hospital death was examined through Cox regression with time-dependent strata defined by: year of first admission; disease group; and the cumulative number of units transfused (≤ 7 days of storage; > 7 days but ≤ 28 days storage; and, >28 days of storage); and, controlling for available baseline and time-varying characteristics. Results 18,843 patients (blood groups A, B and AB), with complete covariates contributed to the analysis. Factors associated with transfusion of mismatched blood included: younger patient age (p<0.0001); lower hemoglobin (p<0.0001); higher creatinine (p<0.0001); intervention during hospitalization (OR=4.6, p<0.0001); and, patient ABO group whereby blood types A and B were much less likely to receive a mismatched unit compared to type AB patients (p<0.0001). There was a statistically significant interaction between patient blood type and the effect of receiving mismatched blood (p=0.034) with type A patients incurring a 79% higher risk of death (RR=1.79, 95% CI: 1.20, 2.67; p=0.0047); other patient blood types did not suggest increased risk. Similar results were observed when suspected trauma patients (≥ 6 units within 24 hours) were excluded from the analysis (Table 1). Conclusion Controlling for known potential confounders through Cox regression yielded evidence of increased risk of in-hospital mortality among blood type A patients receiving group O red cells. This association remained after suspected trauma patients were excluded from the analyses. Further study of the association observed in this study is warranted. Disclosures: Cook: CIHR: Research Funding. Heddle:CIHR: Research Funding; Canadian Blood Services: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Health Canada: Research Funding. Eikelboom:CIHR: Research Funding.

Download Full-text

Plasma ADAMTS13 Activity Associates with Injury Severity in Pediatric Trauma Patients

Blood ◽

10.1182/blood.v128.22.3777.3777 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3777-3777

Author(s):

Jenny K. McDaniel ◽

Ilan I Maizlin ◽

Michelle C. Shroyer ◽

Morgan E. Banks ◽

Jean-Francois Pittet ◽

...

Keyword(s):

Injury Severity ◽

Pediatric Trauma ◽

Initial Presentation ◽

Trauma Patients ◽

Adamts13 Activity ◽

Acute Traumatic Coagulopathy ◽

Time Period ◽

Increased Risk ◽

Significant Difference ◽

Traumatic Coagulopathy

Abstract Background: Acute traumatic coagulopathy occurs in both pediatric and adult trauma patients and is associated with an increased risk of mortality. Trauma patients not only have increased risk for hemorrhagic complications, but also are at increased risk for thrombosis due to multiple factors including local tissue injury, inflammation, and immobility. The complex underlying pathophysiology of coagulation abnormalities associated with traumatic injury have yet to be fully elucidated. Additionally, there are significant differences in the hemostatic system of pediatric patients compared to adults. Objectives: The purpose of this study was to determine the levels of coagulation parameters including von Willebrand factor (VWF) antigen and ADAMTS13 activity in pediatric trauma patients and evaluate for possible association with injury severity and/or mortality. Methods: This study utilized plasma specimens collected from pediatric trauma patients that presented to our institution over a 2-year time period. The specimens were collected at initial presentation and 24 hours later. The injury severity was estimated using both the Glasgow Coma Scale (GCS) and Injury Severity Score (ISS). A cohort of control samples was obtained from pediatric patients for elective surgical procedures over the same time period. Plasma VWF antigen was determined by a sandwich ELISA; plasma ADAMTS13 activity was determined by FRETS-VWF73. The results were determined by nonparametric tests for the differences in median values. Results: A total of 106 trauma patient samples at initial time point, 78 trauma samples at 24 hour time point, and 54 control samples were obtained and utilized for study. There were statistically significant differences (p<0.05) in the plasma levels of VWF antigen, ADAMTS13 activity, and the ratio of ADAMTS13 activity to VWF antigen for the trauma patient samples at initial presentation when compared to controls (Table 1). At 24 hours, there were still statistically significant differences between ADAMTS13 activity and the ratio of ADAMTS13 activity to VWF antigen in trauma patients compared to controls, but there was no significant difference in VWF antigen between the two cohorts (Table 2). There was a significant difference between the decrease in ADAMTS13 activity and injury severity as estimated by ISS ³ 15 or GCS < 8 at both time points; however, ADAMTS13 activity was not statistically different in survivors vs. non-survivors. A higher VWF antigen level at initial presentation was the only factor found to be significantly different in non-survivors. Conclusions: This study demonstrates significant differences in plasma ADAMTS13 activity and VWF antigen in pediatric trauma patients compared to controls. In patients with more severe injuries as estimated by GCS and ISS, there was also a significant association with decreased levels of ADAMTS13 activity. These finding may underlie part of the prothrombotic propensity in microcirculation that occurs in patients post-trauma. Further investigation is warranted to better understand the mechanisms of acute traumatic coagulopathy and potential prognostic factors, and to determine the most effective interventions for acute traumatic coagulopathy in the pediatric population. Disclosures Zheng: Ablynx: Consultancy; Alexion: Research Funding.

Download Full-text