Relationship between admission coagulopathy and prognosis in children with traumatic brain injury: a retrospective study

Cheng-Yan You,Cheng-Yan You,Cheng-Yan You,Feng Xu,Feng Xu,Feng Xu,Yue-Qiang Fu,Yue-Qiang Fu,Yue-Qiang Fu,Yue-Qiang Fu,Yue-Qiang Fu,Si-Wei Lu,Si-Wei Lu,Si-Wei Lu

doi:10.1186/s13049-021-00884-4

Abstract

BackgroundCoagulopathy in adult patients with traumatic brain injury (TBI) is strongly associated with unfavorable outcomes. However, few reports focus on pediatric TBI-associated coagulopathy.MethodsWe retrospectively identified children with Glasgow Coma Scale ≤ 13 in a tertiary pediatric hospital from April 2012 to December 2019 to evaluate the impact of admission coagulopathy on their prognosis. A classification and regression tree (CART) analysis using coagulation parameters was performed to stratify the death risk among patients. The importance of these parameters was examined by multivariate logistic regression analysis.ResultsA total of 281 children with moderate to severe TBI were enrolled. A receiver operating characteristic curve showed that activated partial thromboplastin time (APTT) and fibrinogen were effective predictors of in-hospital mortality. According to the CART analysis, APTT of 39.2 s was identified as the best discriminator, while 120 mg/dL fibrinogen was the second split in the subgroup of APTT ≤ 39.2 s. Patients were stratified into three groups, in which mortality was as follows: 4.5 % (APTT ≤ 39.2 s, fibrinogen > 120 mg/dL), 20.5 % (APTT ≤ 39.2 s and fibrinogen ≤ 120 mg/dL) and 60.8 % (APTT > 39.2 s). Furthermore, length-of-stay in the ICU and duration of mechanical ventilation were significantly prolonged in patients with deteriorated APTT or fibrinogen values. Multiple logistic regression analysis showed that APTT > 39.2 s and fibrinogen ≤ 120 mg/dL was independently associated with mortality in children with moderate to severe TBI.ConclusionsWe concluded that admission APTT > 39.2 s and fibrinogen ≤ 120 mg/dL were independently associated with mortality in children with moderate to severe TBI. Early identification and intervention of abnormal APTT and fibrinogen in pediatric TBI patients may be beneficial to their prognosis.

Highlights

Traumatic brain injury (TBI) is one of the leading causes of trauma-induced mortality and disability in children and adolescents [1]
There is a trend toward increased use of dynamic hemostatic assays such as thromboelastography (TEG), coagulopathy is still commonly diagnosed by routine coagulation laboratory tests, including the International normalized ratio (INR), activated partial thromboplastin time (APTT) and others, in developing countries
Joseph et al [19] defined coagulopathy as a prolonged INR and APTT or a decreased platelet count and found that adult traumatic brain injury (TBI) patients with coagulopathy were more likely to present with a lower GCS score and higher Injury Severity Score (ISS)

Summary

Introduction

Traumatic brain injury (TBI) is one of the leading causes of trauma-induced mortality and disability in children and adolescents [1]. Current research revealed that abnormalities in routine coagulation laboratory tests upon admission were strong predictors of poor outcomes in patients with TBI [5,6,7,8]. Albert et al [8] reported that the mortality of TBI patients with admission coagulopathy, defined by a prolonged INR, prothrombin time (PT) or APTT, was significantly higher than that of the no-coagulopathic group. Et al [6] demonstrated that D-dimer elevation upon admission was significantly associated with progression of intracranial hemorrhage (PICH), which is a major cause of secondary brain injury and a worse outcome after TBI.

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