INTRODUCTION: Few previous studies have been conducted on the severe traumatic brain injury (sTBI)-associated coagulopathy in children. The purpose of this study was to evaluate the incidence and risk factors of sTBI coagulopathy in a pediatric cohort and to evaluate its impact on outcomes. METHODS: Retrospective analysis of pediatric patients (younger than 18 years) sustaining isolated sTBI [head Abbreviated Injury Scale (AIS) score ≥3 and extracranial injuries AIS score <3]. Criteria for sTBI-associated coagulopathy included thrombocytopenia (platelet count <100,000 per mm(3)) and/or elevated international normalized ratio >1.2 and/or prolonged activated partial thromboplastin time >36 seconds. Incidence and risk factors of sTBI coagulopathy and its impact on in-hospital outcomes were analyzed. RESULTS: Overall, 42.8% (n = 137) of the 320 patients studied developed coagulopathy, with increasing incidence in a stepwise fashion with escalating head AIS score (31.1, 46.2, and 88.6% for head AIS score 3, 4, and 5, respectively; p < 0.001). Depressed GCS, increasing age, an ISS ≥16, and brain contusions/lacerations were independently associated with the presence of coagulopathy. The case fatality rate was 7.8% (n = 25); 17.5% versus 0.5% in coagulopathic versus noncoagulopathic patients, respectively. After logistic regression to adjust for confounders, no statistical significant mortality difference in patients with and without coagulopathy was noted (adjusted p = 0.912). CONCLUSIONS: Incidence of coagulopathy in children suffering isolated sTBI is exceedingly high at 40% and reflect the head injury severity. A low GCS, increasing age, ISS ≥16 and intraparenchymal lesions proved to be independently associated with TBI coagulopathy.
INTRODUCTION: Few previous studies have been conducted on the severe traumatic brain injury (sTBI)-associated coagulopathy in children. The purpose of this study was to evaluate the incidence and risk factors of sTBI coagulopathy in a pediatric cohort and to evaluate its impact on outcomes. METHODS: Retrospective analysis of pediatric patients (younger than 18 years) sustaining isolated sTBI [head Abbreviated Injury Scale (AIS) score ≥3 and extracranial injuries AIS score <3]. Criteria for sTBI-associated coagulopathy included thrombocytopenia (platelet count <100,000 per mm(3)) and/or elevated international normalized ratio >1.2 and/or prolonged activated partial thromboplastin time >36 seconds. Incidence and risk factors of sTBI coagulopathy and its impact on in-hospital outcomes were analyzed. RESULTS: Overall, 42.8% (n = 137) of the 320 patients studied developed coagulopathy, with increasing incidence in a stepwise fashion with escalating head AIS score (31.1, 46.2, and 88.6% for head AIS score 3, 4, and 5, respectively; p < 0.001). Depressed GCS, increasing age, an ISS ≥16, and brain contusions/lacerations were independently associated with the presence of coagulopathy. The case fatality rate was 7.8% (n = 25); 17.5% versus 0.5% in coagulopathic versus noncoagulopathicpatients, respectively. After logistic regression to adjust for confounders, no statistical significant mortality difference in patients with and without coagulopathy was noted (adjusted p = 0.912). CONCLUSIONS: Incidence of coagulopathy in children suffering isolated sTBI is exceedingly high at 40% and reflect the head injury severity. A low GCS, increasing age, ISS ≥16 and intraparenchymal lesions proved to be independently associated with TBI coagulopathy.
Authors: Sarah C Christiaans; Amy L Duhachek-Stapelman; Robert T Russell; Steven J Lisco; Jeffrey D Kerby; Jean-François Pittet Journal: Shock Date: 2014-06 Impact factor: 3.454
Authors: Sarah Murphy; Neal J Thomas; Shira J Gertz; John Beca; James F Luther; Michael J Bell; Stephen R Wisniewski; Adam L Hartman; Robert C Tasker Journal: J Neurotrauma Date: 2017-02-27 Impact factor: 5.269
Authors: Brent Whittaker; Sarah C Christiaans; Jessica L Altice; Mike K Chen; Alfred A Bartolucci; Charity J Morgan; Jeffrey D Kerby; Jean-François Pittet Journal: Shock Date: 2013-05 Impact factor: 3.454
Authors: Carolyn M Hendrickson; Benjamin M Howard; Lucy Z Kornblith; Amanda S Conroy; Mary F Nelson; Hanjing Zhuo; Kathleen D Liu; Geoffrey T Manley; Michael A Matthay; Carolyn S Calfee; Mitchell J Cohen Journal: J Trauma Acute Care Surg Date: 2016-06 Impact factor: 3.313
Authors: Elif Soysal; Christopher M Horvat; Dennis W Simon; Michael S Wolf; Elizabeth Tyler-Kabara; Barbara A Gaines; Robert S B Clark; Patrick M Kochanek; Hülya Bayir Journal: Pediatr Crit Care Med Date: 2021-11-01 Impact factor: 3.971
Authors: P P Ghuge; V B Kute; A V Vanikar; M R Gumber; D N Gera; H V Patel; P R Shah; P R Modi; V R Shah; H L Trivedi Journal: Indian J Nephrol Date: 2013-11