Objectives: To investigate the value of plasma D-dimer as a prognostic marker in severe traumatic brain injury in children and to compare the results of plasma D-dimer level in plasma and the clinical condition of the case and the results of its routine laboratory investigations. Methods: The study was carried out on 64 head trauma children 46 cases and 20 controls of both sexes, who admitted to pediatric intensive care unit in Alharam hospital in Giza.All children patients had full history, vital sign, general examination, complete neurological examination, GCS or PGCS, cranial CT scan, abdominal ultrasonography, full radiological studies, plasma D-dimer on admission, the 3rd day and at 14th day, INR, PT, APTT. on admission, the 3rd day and at 14th day, routine laboratory investigations on admission as CBC, CRP, Liver function test, Urea, Creatinine, Blood glucose, Na, K and Arterial blood gas analysis. Results: GCS improved significantly in the favorable group but not in the unfavorable group. D-dimer mean values were significantly higher in the unfavorable group more than the favorable group. D-dimer is correlated with mortality and can predict poor patient outcome. D-dimer have inverse relation with GCS and. PT, aPTT, INR, and Concentration mean values were significantly higher in the unfavorable group than in the favorable group. Conclusion: GCS or PGCS has evident role in evaluation and assessment of TBI especially in acute stage and gives excellent idea about the prognoses of TBI. D-dimer is a good marker to predict outcome in TBI & it has an inverse correlation with GCS or PGCS. PT, aPTT, INR and Concentration have some role in TBI and their values increase in the acute stage of TBI.
Traumatic brain injury is described as a blow to the head or a penetrating head damage which disturb the normal function of the brain. Traumatic brain injuries, in children are common and sometimes are powerful in threatening the life and are leading causes of acquired disability and death. Traumatic brain injury is responsible for nearly 1.4 million injuries and 52 000 deaths annually in the United States. Therefore, in this paper we reviewed the new and recent advances about the management and neuromonitoring in pediatric traumatic brain injury. And to provide a summary of the empirical research on management and rehabilitation in pediatric traumatic brain injury (TBI). Studies of the effectiveness of interventions with children with TBI are hampered by difficulty with combining subjects with various levels of TBI, problems with random assignment to treatment groups, and varying age levels at injury. While these are areas of concern, there are emerging studies that indicate both applied behavioral analysis (ABA) and positive behavioral interventions are helpful to many children. For some children, ABA is not successful, and a shift to positive behavioral interventions has been found to be helpful. Transitions to home and school can be difficult particularly if there are family issues that predated the injury. This review provides additional information for the pediatric neuropsychologist to assist with transition to school and home. Studies utilizing the Internet for family interventions have revealed promising results. Conclusion: Neuromonitoring technology is still at an early stage in pediatric TBI. These improvements have provided the possibility of true multimodal monitoring for useful treatments. But, using clinical functional neuromonitoring would help clinicians to evaluate the managements in hospitals. Studies have indicated that children with severe TBI show significant difficulties with emotional and behavioral adjustment that pose more challenges for intervention and reentry to home and school compared with cognitive and physical issues.
Objectives: To investigate the value of plasma D-dimer as a prognostic marker in severe traumatic brain injury in children and to compare the results of plasma D-dimer level in plasma and the clinical condition of the case and the results of its routine laboratory investigations.
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