The utility of routine trauma laboratories in pediatric trauma resuscitations

Keller, Martin S.; Coln, C. Eric; Trimble, Jennifer A.; Green, M. Christine; Weber, Thomas R.

doi:10.1016/j.amjsurg.2004.08.056

« Previous Next »The American Journal of Surgery
Volume 188, Issue 6 , Pages 671-678, December 2004

The utility of routine trauma laboratories in pediatric trauma resuscitations

Presented at the 56th Annual Meeting of the Southwestern Surgical Congress, Monterey, California, April 18–21, 2004

Martin S. Keller, M.D.
- Department of Pediatric Surgery, Cardinal Glennon Children’s Hospital, 1465 South Grand Boulevard, St. Louis, MO 63104, USA
- Corresponding author. Tel.: +1-314-577-5629; fax: +1-314-268-6454.
C. Eric Coln, M.D.
- Department of Pediatric Surgery, Cardinal Glennon Children’s Hospital, 1465 South Grand Boulevard, St. Louis, MO 63104, USA
Jennifer A. Trimble, B.S.
- Department of Pediatric Surgery, Cardinal Glennon Children’s Hospital, 1465 South Grand Boulevard, St. Louis, MO 63104, USA
M. Christine Green, R.N.
- Department of Pediatric Surgery, Cardinal Glennon Children’s Hospital, 1465 South Grand Boulevard, St. Louis, MO 63104, USA
Thomas R. Weber, M.D.
- Department of Pediatric Surgery, Cardinal Glennon Children’s Hospital, 1465 South Grand Boulevard, St. Louis, MO 63104, USA

Received 20 July 2004; received in revised form 7 August 2004

Abstract

Background

Because of the difficulties in evaluating injured children, screening blood tests are recommended.

Methods

Resuscitation blood tests (complete blood count, chem12, coagulation panel, urinalysis) were reviewed for abnormality frequency, injury correlation, managements, and outcome.

Results

Panels were obtained on 240 children (age <16 years) meeting trauma system criteria. Abnormalities were identified as follows: white blood cell/hematocrit/platelets (41%, 27%, 1%), Na/K/Cl/CO₂ (3%, 30%, 23%, 14%), blood ureal nitrogen/creatinine (6%, 0%), prothrombin time/international normalized ratio/partial thromboplastin time (22%, 16%, 6%), aspartate aminotransferase/alanine transferase (43%, 35%), amylase (2%), glucose (77%), and urinalysis (31%). Organ-specific chemistries predicted injury poorly. Transaminasemia correlated with liver injury when levels exceeded 400 U/L. Two children (1%) with hyperamylasemia had abdominal injuries. Coagulation abnormalities correlated with intracranial injury (43%) and Glasgow Coma Scale (GCS 3 to 8; 56%, GCS 9 to 14; 20%, GCS 15; 14%, P <0.05). Only 25 (10%) had interventions for test abnormalities (11 transfusions, 8 fresh frozen plasma, 3 tests repeated, 3 KCl).