@article{ref1,
title="Coagulopathy After Isolated Severe Traumatic Brain Injury in Children",
journal="Journal of trauma",
year="2011",
author="Talving, Peep and Lustenberger, Thomas and Lam, Lydia and Inaba, Kenji and Mohseni, Shahin and Plurad, David and Green, Donald J. and Demetriades, Demetrios",
volume="71",
number="5",
pages="1205-1210",
abstract="INTRODUCTION:: Few previous studies have been conducted on the severe traumatic brain injury (sTBI)-associated coagulopathy in children. The purpose of this study was to evaluate the incidence and risk factors of sTBI coagulopathy in a pediatric cohort and to evaluate its impact on outcomes. METHODS:: Retrospective analysis of pediatric patients (younger than 18 years) sustaining isolated sTBI [head Abbreviated Injury Scale (AIS) score ≥3 and extracranial injuries AIS score <3]. Criteria for sTBI-associated coagulopathy included thrombocytopenia (platelet count <100,000 per mm) and/or elevated international normalized ratio >1.2 and/or prolonged activated partial thromboplastin time >36 seconds. Incidence and risk factors of sTBI coagulopathy and its impact on in-hospital outcomes were analyzed. RESULTS:: Overall, 42.8% (n = 137) of the 320 patients studied developed coagulopathy, with increasing incidence in a stepwise fashion with escalating head AIS score (31.1, 46.2, and 88.6% for head AIS score 3, 4, and 5, respectively; p < 0.001). Depressed GCS, increasing age, an ISS ≥16, and brain contusions/lacerations were independently associated with the presence of coagulopathy. The case fatality rate was 7.8% (n = 25); 17.5% versus 0.5% in coagulopathic versus noncoagulopathic patients, respectively. After logistic regression to adjust for confounders, no statistical significant mortality difference in patients with and without coagulopathy was noted (adjusted p = 0.912). CONCLUSIONS:: Incidence of coagulopathy in children suffering isolated sTBI is exceedingly high at 40% and reflect the head injury severity. A low GCS, increasing age, ISS ≥16 and intraparenchymal lesions proved to be independently associated with TBI coagulopathy.<p /> <p>Language: en</p>",
language="en",
issn="0022-5282",
doi="10.1097/TA.0b013e31820d151d",
url="http://dx.doi.org/10.1097/TA.0b013e31820d151d"
}