{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T13:44:00Z","timestamp":1754487840260,"version":"3.37.3"},"reference-count":43,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2018,10,8]],"date-time":"2018-10-08T00:00:00Z","timestamp":1538956800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Children undergoing posterior spinal fusion experience high blood loss often necessitating transfusion. An appropriately activated coagulation system provides hemostasis during surgery, but pathologic dysregulation can cause progressive bleeding and increased transfusions. Despite receiving antifibrinolytics for clot stabilization, many patients still require transfusions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>We sought to examine the association of dilutional coagulopathy with blood loss and blood transfusion in posterior spinal fusion for pediatric scoliosis patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective, single institution study of children undergoing posterior spinal fusion &gt;6 levels with a standardized, prospective anesthetic protocol utilizing antifibrinolytics. Blood loss was evaluated using a hematocrit\u2010based calculation. To evaluate transfusions, a normalized Blood Product Transfusion calculation was developed. Factors associated with blood loss and blood transfusions were determined by univariate analysis and multivariate regression modeling with multicollinearity and mediation analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients received 73.7 mL\/kg (standard deviation \u00b130.8) of fluid poor in coagulation factors. Estimated blood loss was 42.6 mL\/kg (standard deviation \u00b118.0). There was a significant association between estimated blood loss and total fluids delivered (Spearman's rho = 0.51, 95% confidence interval 0.33\u20100.65, <jats:italic>P<\/jats:italic> &lt; 0.001). Factors significantly associated with normalized Blood Product Transfusion in this cohort included age, weight, scoliosis type, levels fused, total osteotomies, pelvic fixation, total fluid, maximum prothrombin time, and minimum fibrinogen. Regression modeling showed the best combination of variables for modeling normalized Blood Product Transfusion included patient weight, number of levels fused, total fluid administered, and maximum prothrombin time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Blood product transfusion remains a frustrating problem in pediatric scoliosis. Identifying and controlling dilutional coagulopathy in these patients may reduce blood loss and the need for blood transfusion.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13488","type":"journal-article","created":{"date-parts":[[2018,10,8]],"date-time":"2018-10-08T11:14:42Z","timestamp":1538997282000},"page":"974-981","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Dilutional coagulopathy in pediatric scoliosis surgery: A single center report"],"prefix":"10.1111","volume":"28","author":[{"given":"Courtney E.","family":"Baker","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Mayo Clinic Rochester Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4976-4485","authenticated-orcid":false,"given":"Tanya","family":"Marvi","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9259-869X","authenticated-orcid":false,"given":"Thomas M.","family":"Austin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Emory University School of Medicine Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelby","family":"Payne","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan E.","family":"Mignemi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Gailani","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology and Immunology Vanderbilt University Medical Center Nashville Tennessee"},{"name":"Department of Medicine Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison P.","family":"Wheeler","sequence":"additional","affiliation":[{"name":"Department of Pathology, Microbiology and Immunology Vanderbilt University Medical Center Nashville Tennessee"},{"name":"Department of Pediatrics Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thanh T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine Aurora Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven A.","family":"Lovejoy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey E.","family":"Martus","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory A.","family":"Mencio","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3097-5496","authenticated-orcid":false,"given":"Jonathan G.","family":"Schoenecker","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Vanderbilt University Medical Center Nashville Tennessee"},{"name":"Department of Pathology, Microbiology and Immunology Vanderbilt University Medical Center Nashville Tennessee"},{"name":"Department of Pediatrics Vanderbilt University Medical Center Nashville Tennessee"},{"name":"Department of Pharmacology Vanderbilt University Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,10,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-004-0760-y"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000001019"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200210010-00012"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocl.2013.03.007"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12696"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2011.07.007"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000022460.21283.53"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000165566.82925.14"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2007.01128.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2007.01.002"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2010.03470.x"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.6061\/clinics\/2014(10)04"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.accpm.2015.04.003"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2011.03175.x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2012.03.032"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2014.05.022"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000000530"},{"key":"e_1_2_8_19_1","unstructured":"Black\u2010box FDA warning for Procrit and Epogen.https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2010\/103234s5199lbl.pdf. Accessed May 23 2018"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0b013e3182a22a54"},{"key":"e_1_2_8_21_1","first-page":"Cd006883","article-title":"Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children","volume":"3","author":"Tzortzopoulou A","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200107000-00018"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200504000-00006"},{"key":"e_1_2_8_24_1","first-page":"CD006883","article-title":"Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children","volume":"9","author":"McNicol ED","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2005.03.034"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1159\/000337245"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000280481.18570.27"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31821266e0"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0034-7094(10)70045-3"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq001"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2013.07.460"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aep098"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03005352"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v059.i05"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12723"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/01202412-199804000-00007"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2008.01872.x"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-199508000-00026"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001402"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.13309"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev136"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181d952dc"},{"issue":"1","key":"e_1_2_8_43_1","first-page":"172","article-title":"Intraoperative fresh\u2010frozen plasma versus human albumin in craniofacial surgery\u2013a pilot study comparing coagulation profiles in infants younger than 12 months","volume":"98","author":"Hildebrandt B","year":"2007","journal-title":"Thromb Haemost"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer342"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpan.13488","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.13488","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T18:40:51Z","timestamp":1694889651000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.13488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,8]]},"references-count":43,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1111\/pan.13488"],"URL":"https:\/\/doi.org\/10.1111\/pan.13488","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"type":"print","value":"1155-5645"},{"type":"electronic","value":"1460-9592"}],"subject":[],"published":{"date-parts":[[2018,10,8]]},"assertion":[{"value":"2017-08-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}