Relationship between admission coagulopathy and prognosis in children with traumatic brain injury: a retrospective study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Yue-qiang Fu¹  Cheng-yan You¹  Si-wei Lu¹  Feng Xu¹ 

[1] Department of Critical Care Medicine, Children’s Hospital, Chongqing Medical University, 136# Zhongshan Er Road, Yu Zhong District, 400014, Chongqing, People’s Republic of China;Ministry of Education Key Laboratory of Child Development and Disorders, 400014, Chongqing, People’s Republic of China;National Clinical Research Center for Child Health and Disorders, 400014, Chongqing, People’s Republic of China;China International Science and Technology Cooperation base of Child development and Critical Disorders, 400014, Chongqing, People’s Republic of China;Chongqing Key Laboratory of Pediatrics, 400014, Chongqing, People’s Republic of China;

关键词: Children;    Activated partial thromboplastin time;    Fibrinogen;    Prognosis;    Traumatic brain injury;   

DOI  :  10.1186/s13049-021-00884-4

来源: Springer

【 摘 要 】

BackgroundCoagulopathy in adult patients with traumatic brain injury (TBI) is strongly associated with unfavorable outcomes. However, few reports focus on pediatric TBI-associated coagulopathy.MethodsWe retrospectively identified children with Glasgow Coma Scale ≤ 13 in a tertiary pediatric hospital from April 2012 to December 2019 to evaluate the impact of admission coagulopathy on their prognosis. A classification and regression tree (CART) analysis using coagulation parameters was performed to stratify the death risk among patients. The importance of these parameters was examined by multivariate logistic regression analysis.ResultsA total of 281 children with moderate to severe TBI were enrolled. A receiver operating characteristic curve showed that activated partial thromboplastin time (APTT) and fibrinogen were effective predictors of in-hospital mortality. According to the CART analysis, APTT of 39.2 s was identified as the best discriminator, while 120 mg/dL fibrinogen was the second split in the subgroup of APTT ≤ 39.2 s. Patients were stratified into three groups, in which mortality was as follows: 4.5 % (APTT ≤ 39.2 s, fibrinogen > 120 mg/dL), 20.5 % (APTT ≤ 39.2 s and fibrinogen ≤ 120 mg/dL) and 60.8 % (APTT > 39.2 s). Furthermore, length-of-stay in the ICU and duration of mechanical ventilation were significantly prolonged in patients with deteriorated APTT or fibrinogen values. Multiple logistic regression analysis showed that APTT > 39.2 s and fibrinogen ≤ 120 mg/dL was independently associated with mortality in children with moderate to severe TBI.ConclusionsWe concluded that admission APTT > 39.2 s and fibrinogen ≤ 120 mg/dL were independently associated with mortality in children with moderate to severe TBI. Early identification and intervention of abnormal APTT and fibrinogen in pediatric TBI patients may be beneficial to their prognosis.

【 授权许可】

CC BY