A Retrospective Analysis of Calcium Levels in Pediatric Trauma Patients
*Brian Cornelius1, Angela Cornelius2, Daniel Clark2, Ben Williams2, Phillip Kilgore3, Urska Cvek3, Marjan Trutschl3, *Kevin Boykin2
1Ochsner LSU Health, Shreveport, LA; 2LSU Health, Shreveport, LA; 3LSU Shreveport, Shreveport, LA
Traumatic injury is a major cause of morbidity and mortality in pediatric patients. Hemorrhage is a known but treatable component of these outcomes. Evidence exists that major trauma patients are at high risk for hypocalcemia but the rate of pediatric occurrence is not documented. The purpose of this study was to determine the incidence of hypocalcemia in pediatric trauma patients, as well as to investigate any correlation between hypocalcemia and the need for transfusion and operative intervention. Methods:
After IRB approval a retrospective analysis was conducted of all pediatric trauma patients seen in our Adult Level One, Pediatric Level Two trauma center. A total of 725 patients were identified, 181 were excluded, primarily due to incomplete data. Findings:
Patients were predominantly male following blunt trauma. Initial calcium levels were 8.91 mg/dL, 95% CI and 9.0 mg/dL, 95% CI correcting for albumin levels. Acute declines were noted when comparing initial and corrected serum calcium levels in patients requiring transfusion (8.05mg/dL and 8.67mg/dL) and operative intervention (8.77mg/dL and 8.96mg/dL). 152 (28%) patients required operative intervention, 22 (4%) required transfusion and 8 (1.5%) required massive transfusion. Conclusions (implications for practice):
Patients in our cohort arrived with calcium values on the low end of normal, with a trend towards hypocalcemia if operative intervention or blood transfusion was required. This has been previously associated with increased mortality. Patients requiring operative intervention and transfusion are at increased risk for hypocalcemia and recognition of this potential is key for improved outcomes.
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