Time course of coagulation and fibrinolytic parameters in pediatric traumatic brain injury

Ryuta Nakae MD, PhD1, Yu Fujiki MD, PhD2, Yasuhiro Takayama MD1, Takahiro Kanaya MD1, Yutaka Igarashi MD, PhD1, Go Suzuki MD, PhD2, Yasutaka Naoe MD, PhD2, and Shoji Yokobori MD, PhD1
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  • 1 1Department of Emergency and Critical Care Medicine, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo; and
  • | 2 Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, Kawaguchi-shi, Saitama, Japan
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OBJECTIVE

Coagulopathy is a well-recognized risk factor for poor outcomes in patients with traumatic brain injury (TBI). Differences in the time courses of coagulation and fibrinolytic parameters between pediatric and adult patients with TBI have not been defined.

METHODS

Patients with TBI and an Abbreviated Injury Scale of the head score ≥ 3, in whom the prothrombin time (PT)–international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen concentration, and plasma D-dimer levels were measured on arrival and at 3, 6, and 12 hours after injury, were retrospectively analyzed. Propensity score–matched analyses were performed to adjust baseline characteristics between pediatric patients (aged < 16 years) and adult patients (aged ≥ 16 years).

RESULTS

A total of 468 patients (46 children and 422 adults) were included. Propensity score matching resulted in a matched cohort of 46 pairs. Higher PT-INR and APTT values at 1 to 12 hours after injury and lower fibrinogen concentrations at 1 to 6 hours after injury were observed in the pediatric group compared with the adult group. Plasma levels of D-dimer were elevated in both groups at 1 to 12 hours after injury, but no significant differences were seen between the groups. Multivariate logistic regression analysis of the initial coagulation and fibrinolytic parameters in the pediatric group revealed no prognostic significance of the coagulation parameter values, but elevation of the fibrinolytic parameter D-dimer was an independent negative prognostic factor.

CONCLUSIONS

In the acute phase of TBI, pediatric patients were characterized by prolongation of PT-INR and APTT and lower fibrinogen concentrations compared with adult patients, but these did not correlate with outcome. D-dimer was an independent prognostic outcome factor in terms of the Glasgow Outcome Scale in pediatric patients with TBI.

ABBREVIATIONS

AEDH = acute epidural hematoma; AIS = Abbreviated Injury Scale; APTT = activated partial thromboplastin time; ASDH = acute subdural hematoma; FFP = fresh frozen plasma; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; INR = international normalized ratio; ISS = Injury Severity Score; PT = prothrombin time; TBI = traumatic brain injury; TSAH = traumatic subarachnoid hemorrhage.

Illustration from Soleman et al. (pp 544–552). Copyright Lucille Solomon.

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