Tranexamic acid administration to pediatric trauma patients in a combat setting: The pediatric trauma and tranexamic acid study (PED-TRAX)
Tranexamic acid administration to pediatric trauma patients in a combat setting: The pediatric trauma and tranexamic acid study (PED-TRAX)
复制标题
DOI：
10.1097/ta.0000000000000443
复制
发表时间：
2014-12-01
影响因子：
3.4
通讯作者：
Martin, Matthew J.
中科院分区：
文献类型：
--
作者：
Eckert, Matthew J.;Wertin, Thomas M.;Martin, Matthew J.
背景技术背景：早期使用氨甲环酸（TXA）与严重受伤成人的死亡率和血液制品需求减少有关。它还显示出显着减少失血量和输血的要求，在主要的择期儿科手术，但没有公布的数据已经检查使用TXA在pediatric traumatic.METHODS：这是一个回顾性审查所有儿科创伤入院北大西洋公约组织的角色3医院，营堡垒，阿富汗，从2008年至2012年。对所有患者和选择的亚组进行单变量和逻辑回归分析，以确定与TXA使用和死亡率相关的因素。结果：共有766名18岁或以下的受伤患者（平均[SD]年龄，11 [5]岁; 88%为男性; 73%为穿透性损伤;平均[SD]，损伤严重程度评分[ISS]，10 [9];平均[SD]格拉斯哥昏迷量表[GCS]评分，12 [4]）。在这些患者中，35%的患者在最初24小时内需要输血，10%的患者接受了大量输血，76%的患者需要手术。总死亡率为9%。在766例患者中，66例（9%）接受了TXA。TXA使用的唯一独立预测因素是严重的腹部或四肢损伤（简明损伤量表[AIS]评分？3)和大于5的碱缺乏（所有P < 0.05）。接受TXA治疗的患者与未接受TXA治疗的患者相比，损伤严重程度、低血压、酸中毒和凝血功能障碍更严重。在校正人口统计学、损伤类型和严重程度、生命体征和实验室参数后，TXA的使用与所有患者死亡率的降低独立相关（比值比，0.3; p = 0.03），并且在严重损伤（ISS > 15）和输血患者亚组中显示出相似的趋势。血栓栓塞并发症或其他心血管事件无显著差异。倾向性分析证实了TXA相关的生存优势，并提出了显着改善出院神经系统的状态，以及降低呼吸机dependence.CONCLUSION：TXA被用于约10%的儿科战斗创伤患者，通常在设置严重的腹部或四肢创伤和代谢性酸中毒。TXA给药与死亡率降低独立相关。未发现不良安全性或药物相关并发症。（版权所有（C）2014由Lippincott威廉姆斯& Wilkins）
BACKGROUND: Early administration of tranexamic acid (TXA) has been associated with a reduction in mortality and blood product requirements in severely injured adults. It has also shown significantly reduced blood loss and transfusion requirements in major elective pediatric surgery, but no published data have examined the use of TXA in pediatric trauma.METHODS: This is a retrospective review of all pediatric trauma admissions to the North Atlantic Treaty Organization Role 3 hospital, Camp Bastion, Afghanistan, from 2008 to 2012. Univariate and logistic regression analyses of all patients and select subgroups were performed to identify factors associated with TXA use and mortality. Standard adult dosing of TXA was used in all patients.RESULTS: There were 766 injured patients 18 years or younger (mean [SD] age, 11 [5] years; 88% male; 73% penetrating injury; mean [SD], Injury Severity Score [ISS], 10 [9]; mean [SD] Glasgow Coma Scale [GCS] score, 12 [4]). Of these patients, 35% required transfusion in the first 24 hours, 10% received massive transfusion, and 76% required surgery. Overall mortality was 9%. Of the 766 patients, 66 (9%) received TXA. The only independent predictors of TXA use were severe abdominal or extremity injury (Abbreviated Injury Scale [AIS] score ? 3) and a base deficit of greater than 5 (all p < 0.05). Patients who received TXA had greater injury severity, hypotension, acidosis, and coagulopathy versus the patients in the no-TXA group. After correction for demographics, injury type and severity, vitals, and laboratory parameters, TXA use was independently associated with decreased mortality among all patients (odds ratio, 0.3; p = 0.03) and showed similar trends for subgroups of severely injured (ISS > 15) and transfused patients. There was no significant difference in thromboembolic complications or other cardiovascular events. Propensity analysis confirmed the TXA-associated survival advantage and suggested significant improvements in discharge neurologic status as well as decreased ventilator dependence.CONCLUSION: TXA was used in approximately 10% of pediatric combat trauma patients, typically in the setting of severe abdominal or extremity trauma and metabolic acidosis. TXA administration was independently associated with decreased mortality. There were no adverse safety- or medication-related complications identified. (Copyright (C) 2014 by Lippincott Williams & Wilkins)