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Use of viscoelastic monitoring and prothrombin complex concentrate in a paediatric patient with polytrauma and severe traumatic brain injury
  1. Eric A Sribnick1,2,
  2. Nicole Wenger3,
  3. Kathleen Nicol4,5 and
  4. Joseph D Tobias6,7
  1. 1Department of Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio, USA
  2. 2Deparmtent of Neurosurgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
  3. 3The Ohio State University College of Medicine, Columbus, Ohio, USA
  4. 4Deaprtment of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
  5. 5Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio, USA
  6. 6Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
  7. 7Depatment of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
  1. Correspondence to Dr Eric A Sribnick; eric.sribnick{at}nationwidechildrens.org

Abstract

Viscoelastic monitoring (VEM) tools, such as rotational thrombelastometry, have been used extensively to measure coagulopathy in adults but have received less attention in paediatric care. The presented case involves a 5-year-old boy who was brought to the emergency department after a motor vehicle collision with a Glasgow Coma Scale score of 6T and extensive injuries, including a subdural hematoma. VEM was used to monitor the patient’s coagulopathy and to inform treatment measures by allowing real-time visualisation of the patient’s coagulation status. VEM was additionally used to direct blood product replacement in preparation for neurosurgical intervention, and 4-factor prothrombin complex concentrate (PCC) was used to help reverse the coagulopathy. The patient underwent successful hemicraniectomy after improvement of his coagulopathy. In paediatrics, VEM and PCC are increasingly being used for post-trauma coagulopathy, and this case highlights their potential promise and the need for further research.

  • haematology (incl blood transfusion)
  • neurological injury
  • orthopaedics
  • neurosurgery
  • paediatric intensive care

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Footnotes

  • Contributors All four authors made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. All four authors were involved in drafting the work or revising it critically for important intellectual content. All four authors have given final approval of the version submitted for publication. All four authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Specific involvement in conception, exectution, and revision are as follows: ES was involved in planning and design. ES, NW and KN were involved in data acquisition. ES, KN and JT were involved in data analysis. ES and NW were involved in writing the text. ES and KN were involved in creating the figures. ES, KN and JT were involved in editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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