Rachel P Berger1, Janet Fromkin2, Pam Rubin2, John Snyder3, Rudolph Richichi4, Patrick Kochanek5. 1. Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA; Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), University of Pittsburgh, Pittsburgh, PA. Electronic address: rachel.berger@chp.edu. 2. Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), University of Pittsburgh, Pittsburgh, PA. 3. UPMC Hillman Cancer Center, Pittsburgh, PA. 4. Statistical Analysis and Measurement Consultants, Inc, Lanexa, VA. 5. Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA.
Abstract
OBJECTIVE: To determine whether D-dimer would be increased in children with traumatic brain injury (TBI), specifically mild abusive head trauma. STUDY DESIGN: D-dimer was measured using multiplex bead technology in 195 children <4 years old (n = 93 controls without TBI, n = 102 cases with TBI) using previously collected serum. D-dimer was then measured prospectively in a clinical setting in 44 children (n = 24 controls, n = 20 cases). Receiver operator curves were generated for prospective data. RESULTS: In both the retrospective and prospective cohorts, median (25th-75th percentile) D-dimer was significantly higher in cases vs controls. A receiver operator curve demonstrated an area under the curve of 0.91 (95% CI 0.83-0.99) in the prospective cohort. At a cut-off of 0.59 μg/L, the sensitivity and specificity for identification of a case was 90% and 75%, respectively. CONCLUSIONS: Our data suggest that serum D-dimer may be able to be used to identify which young children at risk for abusive head trauma might benefit from a head computed tomography or other additional evaluation. Additional data are needed to better identify the clinical scenarios that may result in false positive or false negative D-dimer concentrations.
OBJECTIVE: To determine whether D-dimer would be increased in children with traumatic brain injury (TBI), specifically mild abusive head trauma. STUDY DESIGN: D-dimer was measured using multiplex bead technology in 195 children <4 years old (n = 93 controls without TBI, n = 102 cases with TBI) using previously collected serum. D-dimer was then measured prospectively in a clinical setting in 44 children (n = 24 controls, n = 20 cases). Receiver operator curves were generated for prospective data. RESULTS: In both the retrospective and prospective cohorts, median (25th-75th percentile) D-dimer was significantly higher in cases vs controls. A receiver operator curve demonstrated an area under the curve of 0.91 (95% CI 0.83-0.99) in the prospective cohort. At a cut-off of 0.59 μg/L, the sensitivity and specificity for identification of a case was 90% and 75%, respectively. CONCLUSIONS: Our data suggest that serum D-dimer may be able to be used to identify which young children at risk for abusive head trauma might benefit from a head computed tomography or other additional evaluation. Additional data are needed to better identify the clinical scenarios that may result in false positive or false negative D-dimer concentrations.
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