What did we find?

What did we find?

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We included 517 children with major trauma treated across 13 UK hospitals.

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Abnormal calcium levels were common when children first arrived in the Emergency Department:

• 1 in 5 children (19.7%) had a low ionised calcium level.

• 1 in 7 children (13.9%) had a high ionised calcium level.

• This means that approximately 1 in 3 children had an abnormal calcium level on arrival.

 

What about low calcium?

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Children with low calcium were more likely to have low blood pressure and abnormalities in blood clotting. However, after accounting for factors such as the severity of their injuries, low calcium was not independently associated with the need for treatment, poor functional outcome or death.

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This suggests that low calcium may occur alongside physiological disturbance following major trauma, rather than necessarily being an independent cause of worse outcomes.

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What about high calcium?

 

These children appeared to represent a particularly high-risk group. Even after accounting for injury severity and other important factors, high calcium on arrival was independently associated with:

• 2.5 times the odds of a poor functional outcome

• 19 times the odds of death within 24 hours

• 9 times the odds of death within 30 days

 

This is particularly important because the significance of high calcium levels following major trauma in children has not previously been well understood.

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What does this mean?

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Our results suggest that calcium abnormalities are common following major trauma in children, but low and high calcium may mean different things.

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Low calcium was associated with some markers of physiological disturbance but was not independently associated with worse outcomes after adjustment for other factors.

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In contrast, high calcium was strongly associated with poor outcomes and mortality. Rather than necessarily causing these outcomes, high calcium may be a marker of severe physiological stress following injury.

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These findings also suggest that calcium results should be interpreted in the context of the individual child rather than assuming that all calcium abnormalities require correction. In particular, they support caution with replacing calcium in injured children who are not found to have low calcium levels.

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Further research is now needed to understand why high calcium occurs following major trauma and whether it could help clinicians identify children at particularly high risk.