A retrospective analysis of calcium levels in pediatric trauma patients

Brian G Cornelius; Daniel Clark; Ben Williams; Anna Rogers; Andreea Popa; Phillip Kilgore; Urska Cvek; Marjan Trutschl; Kevin Boykin; Angela Cornelius

A retrospective analysis of calcium levels in pediatric trauma patients

Int J Burns Trauma. 2021 Jun 15;11(3):267-274. eCollection 2021.

Authors

Brian G Cornelius^{1

2}, Daniel Clark³, Ben Williams³, Anna Rogers³, Andreea Popa³, Phillip Kilgore⁴, Urska Cvek⁴, Marjan Trutschl⁴, Kevin Boykin³, Angela Cornelius^{3

2}

Affiliations

¹ Graduate Program in Nurse Anesthesia, Texas Wesleyan University Fort Worth, TX, USA.
² Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Hospital Fort Worth, TX, USA.
³ Department of Emergency Medicine, Louisiana State University Health Sciences Center Shreveport, LA, USA.
⁴ Laboratory for Advanced Biomedical Informatics, Department of Computer Science, Louisiana State University Shreveport LA, USA.

PMID: 34336394
PMCID: PMC8310872

Abstract

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. After IRB approval a retrospective analysis was conducted of all pediatric trauma patients seen in our Adult Level One, Pediatric Level Two trauma center. Significance testing for mortality was performed using Pearson's χ² test. For the remaining numeric variables, association was determined one-way analysis of variance (when comparing all classes) or Welch's two-sample t-test (when comparing subsets based on calcium or mortality). In any event, significance was determined using α=0.05. A total of 2,928 patients were identified, 1623 were excluded, primarily due to incomplete data. Patients were predominantly male following blunt trauma. Initial calcium levels were 8.73 mg/dL, 95% CI [4-10.9] and 8.97 mg/dL, 95% CI [6.42-13.1] when correcting for albumin levels. Acute declines were noted when comparing initial and corrected serum calcium levels in patients requiring transfusion (7.99 mg/dL and 8.72 mg/dL) and operative intervention (8.54 mg/dL and 8.91 mg/dL). 456 (34.9%) patients required operative intervention, 138 (10.6%) required transfusion and 29 (2.2%) required massive transfusion. 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.

Keywords: Hypocalcemia; pediatric; transfusion; trauma.