Early Coagulopathy in Pediatric Traumatic Brain Injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) Retrospective Study. Issue 2 (29th April 2021)

• Record Type: Journal Article
• Authors: Chong, Shu-Ling; Ong, Gene Yong-Kwang; Zheng, Charles Qishi; Dang, Hongxing; Ming, Meixiu; Mahmood, Maznisah; Chan, Lawrence Chi Ngong; Chuah, Soo Lin; Lee, Olive Pei Ee; Qian, Suyun; Fan, Lijia; Konoike, Yoshihiko; Lee, Jan Hau
• Is Part Of: Neurosurgery. Volume 89:Issue 2(2021)
• Page Start: 283
• Page End: 290
• Publication Date: 2021-04-29
• Subjects: Blood coagulation disorders -- Brain injuries, Traumatic -- Child -- Mortality -- Critical care outcomes; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyab157
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: 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.