Early coagulopathy in pediatric traumatic brain injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study
Document Type
Article
Publication Date
8-1-2021
Abstract
Although early coagulopathy increases mortality in adults with traumatic brain injury (TBI), less is known about pediatric TBI. OBJECTIVE: To describe the prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet levels of children with moderate to severe TBI to identify predictors of early coagulopathy and study the association with clinical outcomes. METHODS: Using the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) TBI retrospective cohort, we identified patients <16 yr old with a Glasgow Coma Scale (GCS) <= 13. We compared PT, APTT, platelets, and outcomes between children with isolated TBI and multiple trauma with TBI. We performed logistic regressions to identify predictors of early coagulopathy and study the association with mortality and poor functional outcomes. RESULTS: Among 370 children analyzed, 53/370 (14.3%) died and 127/370 (34.3%) had poor functional outcomes. PT was commonly deranged in both isolated TBI (53/173, 30.6%) and multiple trauma (101/197, 51.3%). Predictors for early coagulopathy were young age (adjusted odds ratio aOR] 0.94, 95% CI 0.88-0.99, P = .023), GCS < 8 (aOR 1.96, 95% CI 1.26-3.06, P = .003), and presence of multiple trauma (aOR 2.21, 95% confidence interval CI] 1.37-3.60, P = .001). After adjusting for age, gender, GCS, multiple traumas, and presence of intracranial bleed, children with early coagulopathy were more likely to die (aOR 7.56, 95% CI 3.04-23.06, P < .001) and have poor functional outcomes (aOR 2.16, 95% CI 1.26-3.76, P = .006). CONCLUSION: Early coagulopathy is common and independently associated with death and poor functional outcomes among children with TBI.
Keywords
Blood coagulation disorders, Brain injuries, Traumatic, Child, Mortality, Critical care outcomes
Divisions
fac_med
Funders
SingHealth[SHF/FG670P/2017]
Publication Title
Neurosurgery
Volume
89
Issue
2
Publisher
Oxford Univ Press Inc
Publisher Location
JOURNALS DEPT, 2001 EVANS RD, CARY, NC 27513 USA