{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T22:32:45Z","timestamp":1769639565994,"version":"3.49.0"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2016,8,11]],"date-time":"2016-08-11T00:00:00Z","timestamp":1470873600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Operative treatment of craniosynostosis is associated with substantial blood loss, often requiring transfusion of packed red blood cells (<jats:styled-content style=\"fixed-case\">PRBC<\/jats:styled-content>) and coagulation products.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>The aim of this prospective study was to analyze thromboelastographic (<jats:styled-content style=\"fixed-case\">TEG<\/jats:styled-content>) parameters and platelet fibrinogen product to determine predictors of substantial blood loss, and the need for <jats:styled-content style=\"fixed-case\">PRBC<\/jats:styled-content> transfusion and coagulation products.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>With <jats:styled-content style=\"fixed-case\">IRB<\/jats:styled-content> approval, we enrolled 120 children undergoing craniosynostosis repair with a standardized anesthetic, fluid management, and <jats:styled-content style=\"fixed-case\">TEG<\/jats:styled-content> measurements at predefined times. Outcomes of interest were intraoperative blood loss, and need for <jats:styled-content style=\"fixed-case\">PRBC<\/jats:styled-content> transfusion and coagulation products. Multivariable logistic regression and receiver operating characteristic (<jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content>) curve analysis was applied to determine independent predictors of substantial blood loss and need for coagulation products.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and eighteen children were included in the analysis. Forty\u2010four required <jats:styled-content style=\"fixed-case\">PRBC<\/jats:styled-content> transfusion (median 26 ml\u00b7kg<jats:sup>\u22121<\/jats:sup>; <jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>: 22\u201342) with median blood loss of 56 ml\u00b7kg<jats:sup>\u22121<\/jats:sup> (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>: 43\u201383). Factors associated with the <jats:styled-content style=\"fixed-case\">PRBC<\/jats:styled-content> transfusion included type of surgery, duration of surgery, and three <jats:styled-content style=\"fixed-case\">TEG<\/jats:styled-content> parameters, <jats:italic>\u03b1<\/jats:italic>\u2010angle, <jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content>, and K\u2010time (all <jats:italic>P<\/jats:italic> &lt; 0.001). A predictive algorithm was developed by subgroup analysis of cranial vault reconstruction (<jats:styled-content style=\"fixed-case\">CVR<\/jats:styled-content>) patients for substantial intraoperative blood loss (defined as \u226560 ml\u00b7kg<jats:sup>\u22121<\/jats:sup>) and need for coagulation products with <jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content>\u2010derived cut\u2010off values: platelet fibrinogen product, &lt;343; <jats:italic>\u03b1<\/jats:italic>\u2010angle, &lt;62\u00b0; <jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content>, &lt;55 mm; K\u2010time, &gt;2.1 min. The best prognostic combination included at least two of these four predictors (sensitivity 89%, specificity 90%). Multivariable regression identified <jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content> as the only independent predictor of coagulation product administration (<jats:italic>P<\/jats:italic> &lt; 0.001) and <jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content> analysis identified <jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content> &lt;46 mm as the optimal cut\u2010off (sensitivity 86%, specificity 94%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Risk for substantial intraoperative blood loss can be assessed using <jats:styled-content style=\"fixed-case\">TEG<\/jats:styled-content> parameters and platelet fibrinogen product, whereas the need for coagulation products is strongly related to low <jats:styled-content style=\"fixed-case\">MA<\/jats:styled-content>. Patients susceptible to substantial blood loss can be risk stratified based on their <jats:styled-content style=\"fixed-case\">TEG<\/jats:styled-content>\/platelet fibrinogen product profile.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.12980","type":"journal-article","created":{"date-parts":[[2016,8,11]],"date-time":"2016-08-11T10:46:37Z","timestamp":1470912397000},"page":"960-969","source":"Crossref","is-referenced-by-count":17,"title":["Multivariable predictors of substantial blood loss in children undergoing craniosynostosis repair: implications for risk stratification"],"prefix":"10.1111","volume":"26","author":[{"given":"Petra M.","family":"Meier","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Perioperative and Pain Medicine Boston Children's Hospital and Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Zurakowski","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Perioperative and Pain Medicine Boston Children's Hospital and Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan M.","family":"Goobie","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Perioperative and Pain Medicine Boston Children's Hospital and Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark R.","family":"Proctor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Boston Children's Hospital and Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John G.","family":"Meara","sequence":"additional","affiliation":[{"name":"Department of Plastic and Oral Surgery Boston Children's Hospital and Harvard Medical School Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa 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