Early Coagulopathy in Pediatric Traumatic Brain Injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) Retrospective Study

Chong SL 1 , Ong GY 1 , Zheng CQ 2 , Dang H 3 , Ming M 4 , Mahmood M 5 Show all authors , Chan LCN 6 , Chuah SL 7 , Lee OPE 8 , Qian S 9 , Fan L 10 , Konoike Y 11 , Lee JH 12

Affiliations 

  • 1 Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
  • 2 Singapore Clinical Research Institute, Singapore
  • 3 Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China
  • 4 Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
  • 5 Department of Paediatrics, Institute of Paediatric, Kuala Lumpur, Malaysia
  • 6 Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
  • 7 Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia
  • 8 Department of Paediatrics, Sarawak General Hospital, Sarawak, Malaysia
  • 9 Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
  • 10 Khoo Teck Puat National University Children's Medical Institute, National University Hospital, Singapore
  • 11 Department of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
  • 12 Duke-NUS Medical School, Singapore
Neurosurgery, 2021 07 15;89(2):283-290.
PMID: 33913493 DOI: 10.1093/neuros/nyab157

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

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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