Introduction: Disseminated intravascular coagulation (DIC) is characterized by activation of coagulation from various causes. Although, global hemostatic tests including rotational thromboelastrometry (ROTEM®) and clot waveform analysis (CWA) have been reported as a diagnostic tools in adult with DIC, exploration in pediatric field is still limited.
Objective: To determine test performances and added value of ROTEM® and CWA for diagnosis of overt DIC (ODIC) in critically ill children.
Materials and Methods: This prospective observational study included children aged 1 month - 18 years in PICU at Chiang Mai University hospital. Patients with underlying conditions predisposing to DIC were enrolled. After 24 hours of admission, ROTEM® and CWA were performed along with the standard parameters. In case of non-overt DIC (NDIC), investigations were repeated on day 3 – 5.
Results: Sixty-four children who met the inclusion criteria were analyzed. An incidence of ODIC by ISTH-DIC score was 20.3%. Comparison of baseline ROTEM® (EXTEM, INTEM) and CWA (Min1, Min2, Max2) parameters in ODIC and NDIC cases were significantly different. Using EXTEM-CFT cut-off of > 102 s provided sensitivity and specificity of 90.9% and 80.9%, respectively, of making diagnosis of ODIC with excellent area under the curve (AUC) of 0.86. For the performance of CWA, biphasic waveform was not observed in any children with ODIC. However, both Min2 of < 0.35 %/s2 and Max2 of < 0.25 %/s2 had equal 76.9% sensitivity and 79.6% specificity with acceptable AUC of 0.78. By combining INTEM-CFT, EXTEM-CFT and Min2 significantly increased AUC compared to EXTEM-CFT alone (0.92 vs 0.86, p<0.05). Bleeding was the most common consequence of DIC in this study. Lower EXTEM-α-angle (66.7 o ± 19.5o vs 74.3 o ± 6.3 o, p 0.03) was associated with bleeding complications.
Conclusions: Global hemostatic tests including ROTEM® and CWA were a valuable diagnostic tool in critically ill children who might require point-of-care test for further treatment.
Keywords: rotational thromboelastrometry, clot waveform analysis, disseminated intravascular coagulation, children
