Laboratory Markers in the Management of Pediatric Polytrauma: Current Role and Areas of Future Research

Abstract

Severe trauma is the most common cause of mortality in children and is associated with a high socioeconomic burden. The most frequently injured organs in children are the head and thorax, followed by the extremities and by abdominal injuries. The efficient and early assessment and management of these injuries is essential to improve patients' outcome. Physical examination as well as imaging techniques like ultrasound, X-ray and computer tomography are crucial for a valid early diagnosis. Furthermore, laboratory analyses constitute additional helpful tools for the detection and monitoring of pediatric injuries. Specific inflammatory markers correlate with post-traumatic complications, including the development of multiple organ failure. Other laboratory parameters, including lactate concentration, coagulation parameters and markers of organ injury, represent further clinical tools to identify trauma-induced disorders. In this review, we outline and evaluate specific biomarkers for inflammation, acid-base balance, blood coagulation and organ damage following pediatric polytrauma. The early use of relevant laboratory markers may assist decision making on imaging tools, thus contributing to minimize radiation-induced long-term consequences, while improving the outcome of children with multiple trauma.

Whole-Body Magnetic Resonance Tomography and Whole-Body Computed Tomography in Pediatric Polytrauma Diagnostics—A Retrospective Long-Term Two-Center Study

“…It must be emphasized that this study was focused on factors, such as the mechanisms of accidents, the preclinical course of traumatized children, and clinical parameters, to decide on the required imaging modality. However, there are biomarkers, such as interleukin-6 and troponin, which correlate with the injury severity after trauma in children [ 34 , 35 ]. Currently, it remains uncertain if these molecules are significantly elevated as early as minutes or a few hours after trauma.…”

Pathophysiological changes and injury markers for acute lung injury from blunt impact in infant rabbits

“…Forty 4-week-old young rabbits (as infant for average human weaning stage for 6 months) ( 1 ) weighing between 0.9–1.0 kg were randomly assigned into four groups: control, 0-h (h), 24 h, and 72 h (each group of rabbits was assessed only at the corresponding time after injury). Animals of both sexes were randomly grouped.…”

“…Road traffic injury presents a serious hazard to children, with traffic accidents accounting for 78% of severe injuries in this demographic, compared to 63% in adults ( 1 , 2 ). The distinction in seating postures between children and adults in motor vehicles contributes to the increased incidence of chest and abdominal injuries in children, reaching as high as 13%, surpassed only by head and neck injuries ( 3 ).…”

Bicarbonate and Serum Lab Markers as Predictors of Mortality in the Trauma Patient

“… 4 , 5 Many of these studies have revealed that serum lactate is a reliable predictor of mortality in severely injured patients 4 , 6 , 7 and may even outperform arterial base deficit as a predictive tool. 8 , 9 Additionally, some smaller studies have indicated that both arterial and venous bicarbonate values can effectively predict mortality in critical care settings. 2 , 7 , 8 Serum bicarbonate and base deficit have been found to be approximately equivalent in their predictive capacity in other studies.…”

“… 2 , 7 , 8 Serum bicarbonate and base deficit have been found to be approximately equivalent in their predictive capacity in other studies. 7 Given that lactic acid measurements and arterial base deficit may not be immediately available at the time of a patient’s initial presentation, 9 further exploration of the predictive value of bicarbonate measures becomes critical.…”