Abnormalities in fibrinolysis at the time of admission are associated with DVT, mortality and disability in a pediatric trauma population.

Abstract Abnormalities in fibrinolysis are common and associated with increased mortality in injured adults. While hyperfibrinolysis (HF) and fibrinolysis shutdown (SD) are potential prognostic indicators and treatment targets in adults, these derangements are not well-described in a pediatric trauma cohort. Prospective analysis of highest level trauma activations age 0-18 presenting to our academic center between 6/1/2015-7/31/2016 with admission rapid thromboelastogram (TEG). Shutdown was defined as LY30 ≤0.8% and hyperfibrinolysis defined as LY30≥3.0%. Variables of interest included demographics, admission vitals and labs, injuries, incidence of venous thromboembolism under our screening protocol, death and functional disability (discharge to facility or dependence in functional independence measure category). Youden index determined optimal definition of shutdown, then Wilcoxon rank-sum, Kruskal-Wallis and Fisher exact tests were performed. 133 patients are included with median(IQR) age=10(5-13) years, male sex=75.4%, ISS=17(10-26), blunt mechanism=68.4%. Youden analysis defined shutdown as LY30≤0.8. In total, 38.3%(n=51) had SD on admission; 19.6%(n=26) had HF and 42.1%(n=56) were normal. Mortality rate was 9.0% (n=12) and DVT incidence was 10.7% (n=13/121 surviving). SD and HF were both associated with mortality (p=0.014 and p=0.021) and blood transfusion (p=0.001 and p