Non-invasive hemodynamic monitoring and cardiac preload assessment in severely injured children in the emergency department.

Abstract

Objectives: This study aimed to evaluate cardiac preload and identify early predictors of severe trauma in pediatric patients using non-invasive hemodynamic monitoring in the pediatric emergency department.

Methods: A prospective cohort study was conducted at Xi'an Children's Hospital (June 2022-October 2024) with 167 patients, divided into mild (84) and severe (83) trauma groups. Non-invasive monitoring began shortly after admission, collecting parameters alongside clinical and laboratory assessments.

Results: No significant differences in demographics or injury characteristics were found between groups. The severe trauma group had higher blood transfusion requirements (TAR) (p < 0.01). Hemodynamic parameters showed reduced pre-ejection period (PEP), left ventricular ejection time, and thoracic fluid content (t = 5.655, z = -4.368, z = -3.702; p < 0.01), indicating insufficient preload. Elevated heart rate (t = -4.127; p < 0.01) compensated for this. Reduced stroke volume index (t = 2.339, p < 0.05) and higher cardiac index (z = -1.979; p < 0.05) suggested compensation for low hemoglobin. The severe group also had elevated white blood cells, blood glucose, lactate, interleukin-6, interleukin-10, ALT, and AST (p < 0.01), while hemoglobin, fibrinogen, and albumin were decreased (p < 0.01). Logistic regression identified PEP, albumin, interleukin-6, and TAR as independent risk factors for severe trauma (p < 0.05). PEP and interleukin-6 had the highest area under the curve values (> 0.70).

Conclusions: Non-invasive hemodynamic monitoring can detect early signs of insufficient preload in severe pediatric trauma, and the combination of PEP and interleukin-6 aids in severity assessment and clinical decision-making.

Clinical trial registration: Not applicable.