Delay Sudden Death in Pediatric Traumatic Patients Followed Venous Thromboembolism and Review of Literatures for Decision Making

Purpose:Differences between children and adults with respect to patterns of injury, physiologic presentation, and management are important, particularly in children younger than 2 years. Venous thromboembolism (VTE) is a major source of morbidity in critically ill trauma patients. Although the incidence and risk factors for VTE after trauma in adults have been well described, similar data regarding pediatric patientsare lacking. Cases Presentation:Case 1:3 year old male, multiple injuries followed car accident that referred to us unstable, whit GCS=5, paraplegic, T9 compression fracture, left side pleural effusion and peritonitis. After portable US, Chest, pelvic, neck, spines X Ray and Prednisolon prescription, first he underwent laparatomy. He had left side diaphragmatic rupture, superficial spleen laceration, none expanding retroperitoneal hematoma, multiple intestinal rupture and rectum laceration.Then he underwent thoracotomy for T9 fixation. 2 weeks after admission followed refractory erosive gastritis, we performed over swing vagotomy and pyloroplasty. 1.5 month after trauma he had sudden death and we suspected to thrombi emboli.Case 2:3 year female, multiple trauma followed truck accident with pelvic fracture and extensive laceration of rectum, labia, vagina and urethra that head CT scan and all spines were normal. She underwent colostomy, cystostomy, urethroplasty, vagina and rectum repair and pelvic traction. 2 weeks later, after beginning of activation she had sudden death. That probable pathology is thromboembolism. Conclusion:Trauma patients are at risk for venous thromboembolism. Trauma patients at a higher risk than the general trauma population include those with coma or severe head injury, spinal cord injury, and severe fractures of the pelvis or long bones. Administration of LMWH is initiated as soon as bleeding has been controlled and there is no intracranial pathology. Additionally, pulsatile compression stocking are usedroutinely unless there is a fracture.