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

Vigil James MRCPCH, Shu-Ling Chong MPH, Shanti S. Shetty MBBS and Gene Y. Ong MRCPCH
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  • Children’s Emergency, KK Women’s and Children’s Hospital, Singapore
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OBJECTIVE

Traumatic 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.

METHODS

This 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).

RESULTS

In 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.

CONCLUSIONS

TBI-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.

ABBREVIATIONS AIS head = Abbreviated Injury Scale of the head; aPTT = activated partial thromboplastin time; ED = emergency department; GCS = Glasgow Coma Scale; GOS-E Peds = pediatric version of the Glasgow Outcome Scale–Extended; INR = international normalized ratio; MVC = motor vehicle collision; NAI = nonaccidental injury; PT = prothrombin time; TBI = traumatic brain injury.

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Contributor Notes

Correspondence Gene Y. Ong: Children’s Emergency, KK Women’s and Children’s Hospital, Singapore. geneong@yahoo.com.

INCLUDE WHEN CITING Published online March 6, 2020; DOI: 10.3171/2019.12.PEDS19531.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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