The role of coagulopathy on clinical outcome following traumatic brain injury in children: analysis of 66 consecutive cases in a single center institution

Podolsky-Gondim, Guilherme Gozzoli; Furlanetti, Luciano; Viana, Dinark Conceição; Ballestero, Matheus Fernando Manzolli; Oliveira, Ricardo Santos de

doi:10.1007/s00381-018-3989-1

Cited by 18 publications

(13 citation statements)

References 31 publications

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“…In children, TBI may also induce coagulopathy. Coagulopathy has been found to be associated with increased mortality in pediatric TBI patients [19,20,25]. Our study also suggested that initial coagulopathy was an independent predictor of mortality in these school-aged patients with severe TBI.…”

Section: Discussionsupporting

confidence: 69%

“…The parameters selected as potential predictors of mortality in patients with severe TBI included sex; age; mechanism of head injury; initial clinical presentation in ED, including the motor component of the GCS (mGCS); hypotension; hypothermia; initial laboratory data showing hyperglycemia; coagulopathy; and intracranial CT findings in the ED. We selected these parameters based on previous studies [11,[19][20][21][22][23][24][25][26][27][28] that suggested that these were potential risk factors for injury severity and mortality in pediatric head injury patients.…”

Section: Variable Definitionsmentioning

confidence: 99%

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Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury

Chen

et al. 2021

Brain Sciences

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Traumatic brain injury (TBI) is the leading cause of mortality in children. There are few studies focused on school-aged children with TBI. We conducted this study to identify the early predictors of in-hospital mortality in school-aged children with severe TBI. In this 10 year observational cohort study, a total of 550 children aged 7–18 years with TBI were enrolled. Compared with mild/moderate TBI, children with severe TBI were older; more commonly had injury mechanisms of traffic accidents; and more neuroimage findings of subarachnoid hemorrhage (SAH), subdural hemorrhage (SDH), parenchymal hemorrhage, cerebral edema, and less epidural hemorrhage (EDH). The in-hospital mortality rate of children with severe TBI in our study was 23%. Multivariate analysis showed that falls, being struck by objects, motor component of Glasgow coma scale (mGCS), early coagulopathy, and SAH were independent predictors of in-hospital mortality. We concluded that school-aged children with severe TBI had a high mortality rate. Clinical characteristics including injury mechanisms of falls and being struck, a lower initial mGCS, early coagulopathy, and SAH are predictive of in-hospital mortality.

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Section: Discussionsupporting

confidence: 69%

Section: Variable Definitionsmentioning

confidence: 99%

Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury

Chen

et al. 2021

Brain Sciences

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“…The parameters selected as potential predictors of mortality in patients with severe RTA-related TBI included age, gender, type of road user, and initial clinical presentation to the ED, including the motor component of the GCS (mGCS) score, hypotension, hypothermia, and initial laboratory data, including hyperglycemia, a prolonged prothrombin time, and intracranial CT findings. We selected these reliable parameters based on previous studies that suggested potential risk factors for injury severity and mortality in pediatric TBI [14,[20][21][22][23][24][25][26][27][28][29].…”

Section: Variable Definitionsmentioning

confidence: 99%

Predictors of In-Hospital Mortality for Road Traffic Accident-Related Severe Traumatic Brain Injury

Chen

Hsieh

Huang

et al. 2021

JPM

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(1) Background: Road traffic accidents (RTAs) are the leading cause of pediatric traumatic brain injury (TBI) and are associated with high mortality. Few studies have focused on RTA-related pediatric TBI. We conducted this study to analyze the clinical characteristics of RTA-related TBI in children and to identify early predictors of in-hospital mortality in children with severe TBI. (2) Methods: In this 15-year observational cohort study, a total of 618 children with RTA-related TBI were enrolled. We collected the patients’ clinical characteristics at the initial presentations in the emergency department (ED), including gender, age, types of road user, the motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and the intracranial computed tomography (CT) Rotterdam score, as potential mortality predictors. (3) Results: Compared with children exhibiting mild/moderate RTA-related TBI, those with severe RTA-related TBI were older and had a higher mortality rate (p < 0.001). The in-hospital mortality rate for severe RTA-related TBI children was 15.6%. Compared to children who survived, those who died in hospital had a higher incidence of presenting with hypothermia (p = 0.011), a lower mGCS score (p < 0.001), a longer initial prothrombin time (p < 0.013), hyperglycemia (p = 0.017), and a higher Rotterdam CT score (p < 0.001). Multivariate analyses showed that the mGCS score (adjusted odds ratio (OR): 2.00, 95% CI: 1.28–3.14, p = 0.002) and the Rotterdam CT score (adjusted OR: 2.58, 95% CI: 1.31–5.06, p = 0.006) were independent predictors of in-hospital mortality. (4) Conclusions: Children with RTA-related severe TBI had a high mortality rate. Patients who initially presented with hypothermia, a lower mGCS score, a prolonged prothrombin time, hyperglycemia, and a higher Rotterdam CT score in brain CT analyses were associated with in-hospital mortality. The mGCS and the Rotterdam CT scores were predictive of in-hospital mortality independently.

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“…The association of coagulopathy with isolated TBI is an evolving concept in the treatment of pediatric patients, with limited available published literature on this topic. With the exception of a small observational study (n = 66), 22 other reported studies on TBI-associated coagulopathy in the pediatric population used in-hospital outcome measures like death and ICU stay and did not address neurological outcomes, which is the critical focus of management for survivors with moderate to severe TBI. 3,21,25,28,29…”

mentioning

confidence: 99%

Early coagulopathy in children with isolated blunt head injury is associated with mortality and poor neurological outcomes

James¹,

Chong²,

Shetty³

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVETraumatic brain injury (TBI) is the leading cause of long-term disability and death in children and adolescents globally. Long-term adverse outcomes, including physical, cognitive, and behavioral sequelae, have been reported after TBI in a significant number of pediatric patients. In this study the authors sought to investigate the epidemiology of TBI-associated coagulopathy and its association with mortality and poor neurological outcome in a pediatric population with isolated moderate to severe blunt head injury treated at the authors’ institution.METHODSThis retrospective study was conducted in the children’s emergency department between January 2010 and December 2016. Children < 18 years old who presented with isolated moderate to severe blunt head injury were included in the study. The authors collected data on patient demographics, clinical presentation, and TBI management. Outcomes studied were death and poor neurological outcome defined by a score of < 7 (death, moderate to severe neurological disability) at 6 months postinjury on the pediatric version of the Glasgow Outcome Scale–Extended (GOS-E Peds).RESULTSIn 155 pediatric patients who presented with isolated moderate to severe blunt head injury, early coagulopathy was observed in 33 (21.3%) patients during the initial blood investigations done in the emergency department. The mean (SD) age of the study group was 7.03 (5.08) years and the predominant mechanism of injury was fall from height (65.2%). The median Abbreviated Injury Scale of the head (AIS head) score was 4 and the median GCS score was 13 (IQR 12–15). TBI-associated coagulopathy was independently associated with GOS-E Peds score < 7 (p = 0.02, adjusted OR 6.07, 95% CI 1.32–27.83). The overall mortality rate was 5.8%. After adjusting for confounders, only AIS head score and hypotension at triage remained significantly associated with TBI-associated coagulopathy.CONCLUSIONSTBI-associated coagulopathy was independently associated with GOS-E Peds score < 7 at 6 months postinjury. Larger prospective studies are needed to investigate the use of TBI-associated coagulopathy to prognosticate these critical clinical outcomes.

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The role of coagulopathy on clinical outcome following traumatic brain injury in children: analysis of 66 consecutive cases in a single center institution

Cited by 18 publications

References 31 publications

Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury

Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury

Predictors of In-Hospital Mortality for Road Traffic Accident-Related Severe Traumatic Brain Injury

Early coagulopathy in children with isolated blunt head injury is associated with mortality and poor neurological outcomes

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