LAUSR

Introduction Acute traumatic coagulopathy is a clinically distinct coagulopathy resulting from the injury itself and subsequent hypoperfusion. The condition has been associated with increased morbidity and mortality in adults but little is known about the condition in children. Objective This review aims to summarise current literature regarding the incidence of acute traumatic coagulopathy in a paediatric population and associated risk factors and outcomes. Evidence review We carried out searches of Medline, EMBASE and Cochrane library databases as well as the following registries: clinicaltrials.gov, the European Union Clinical Trials Register and the International Standard Randomised Controlled Trial Number (ISRCTN) registry. Searches were limited to studies published from 2003, the point at which acute traumatic coagulopathy was defined. For each relevant study identified, reference and author specific searches were carried out. Finally, the grey literature was searched. Any study defining acute traumatic coagulopathy as an international normalised ratio (INR) >1.2, including individuals aged 17 or less with any type of traumatic injury was eligible. Results We identified a total of nine studies that met the inclusion criteria. All studies were retrospective cohort studies deemed to be at low or uncertain risk of bias. Eight studies were conducted in trauma centres in the United States and one in combat support hospitals in Iraq and Afghanistan. Study populations ranged from 84 to 1531 participants. Acute traumatic coagulopathy was present in 31.7% (range 24.6%–40.9%). Mortality was 29.3% (range 21.2%–60%) in those who were coagulopathic on admission versus 3.2% (range 0%–6%) in those with normal coagulation studies. Data regarding risk factors and additional outcomes such as transfusion requirements and thrombosis were limited. Conclusions Acute traumatic coagulopathy is present in around one third of severely injured paediatric patients and is associated with increased mortality, particularly in individuals with isolated brain injuries. The incidence of the condition in the wider paediatric trauma population who do not require admission to intensive care remains largely unknown but may be less common. There was limited data regarding the risk factors and additional outcomes associated with acute traumatic coagulopathy.