ObjectivesTo determine the prevalence of abnormal coagulation studies and to identify variables associated with markedly elevated coagulation studies in children with blunt trauma.MethodsWe reviewed the medical records of all patients 15 years old hospitalized at a Level 1 trauma center for either blunt head or torso trauma over a 4-year period. Data from each patientrsquo;s emergency department (ED) presentation were abstracted. ED coagulation studies were defined prior to data analysis as elevated if the international normalized ratio (INR) was ge;1.2 or partial thromboplastin time (PTT) was ge;33.0 seconds and markedly elevated if the INR was ge;1.5 or PTT was ge;40 seconds. Variables associated with markedly elevated coagulation studies in a univariate analysis (P 0.05) were entered into a backward elimination logistic regression analysis to identify variables independently associated with markedly elevated coagulation studies.ResultsA total of 1082 patientsrsquo; records were reviewed, and the 830 (77percnt;) patients with coagulation studies obtained composed the study population. Elevated coagulation studies were detected in 232 (28percnt;) patients, and 49 (6percnt;) of these were found to be markedly elevated. In the multivariate analysis, a GCS le;13 (odds ratio lsqb;ORrsqb; 8.7, 95percnt; confidence interval lsqb;CIrsqb; 4.3, 17.7), low systolic blood pressure (OR 4.0, 95percnt; CI 1.6, 9.9), open/multiple bony fractures (OR 2.9, 95percnt; CI 1.4, 6.2), and major tissue wounds (OR 2.8, 95percnt; CI 1.4, 5.6) were independently associated with markedly elevated coagulation studies.ConclusionHospitalized pediatric blunt trauma patients frequently have minor elevations in ED coagulation studies. Marked elevations occur infrequently and are independently associated with a GCS le;13, low systolic blood pressure, open/multiple bony fractures, and major tissue wounds.
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