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

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.

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Age-Related Differences in the Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury

International Journal of Molecular Sciences ◽

10.3390/ijms21165613 ◽

2020 ◽

Vol 21 (16) ◽

pp. 5613

Author(s):

Ryuta Nakae ◽

Yu Fujiki ◽

Yasuhiro Takayama ◽

Takahiro Kanaya ◽

Yutaka Igarashi ◽

...

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Propensity Score ◽

Older Patients ◽

Multivariate Logistic Regression Analysis ◽

The Elderly ◽

Elderly Group ◽

Post Injury ◽

D Dimer

Coagulopathy and older age are common and well-recognized risk factors for poorer outcomes in traumatic brain injury (TBI) patients; however, the relationships between coagulopathy and age remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more pronounced in older patients and may be a factor in poorer outcomes. We retrospectively evaluated severe TBI cases in which fibrinogen and D-dimer were measured on arrival and 3–6 h after injury. Propensity score-matched analyses were performed to adjust baseline characteristics between older patients (the “elderly group,” aged ≥75 y) and younger patients (the “non-elderly group,” aged 16–74 y). A total of 1294 cases (elderly group: 395, non-elderly group: 899) were assessed, and propensity score matching created a matched cohort of 324 pairs. Fibrinogen on admission, the degree of reduction in fibrinogen between admission and 3–6 h post-injury, and D-dimer levels between admission and 3–6 h post-injury were significantly more abnormal in the elderly group than in the non-elderly group. On multivariate logistic regression analysis, independent risk factors for poor prognosis included low fibrinogen and high D-dimer levels on admission. Posttraumatic coagulation and fibrinolytic abnormalities are more severe in older patients, and fibrinogen and D-dimer abnormalities are negative predictive factors.

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Computed tomography characteristics in pediatric versus adult traumatic brain injury

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.12.peds13223 ◽

2014 ◽

Vol 13 (3) ◽

pp. 307-314 ◽

Cited By ~ 21

Author(s):

Korak Sarkar ◽

Krista Keachie ◽

UyenThao Nguyen ◽

J. Paul Muizelaar ◽

Marike Zwienenberg-Lee ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pediatric Patients ◽

Clinical Care ◽

Pediatric Trauma ◽

Adult Patients ◽

Clinical Severity ◽

Ct Findings ◽

Severity Of Injury ◽

Pediatric Tbi

Object Traumatic brain injury (TBI) is a leading cause of injury, hospitalization, and death among pediatric patients. Admission CT scans play an important role in classifying TBI and directing clinical care, but little is known about the differences in CT findings between pediatric and adult patients. The aim of this study was to determine if radiographic differences exist between adult and pediatric TBI. Methods The authors retrospectively analyzed TBI registry data from 1206 consecutive patients with nonpenetrating TBI treated at a Level 1 adult and pediatric trauma center over a 30-month period. Results The distribution of sex, race, and Glasgow Coma Scale (GCS) score was not significantly different between the adult and pediatric populations; however, the distribution of CT findings was significantly different. Pediatric patients with TBI were more likely to have skull fractures (OR 3.21, p < 0.01) and epidural hematomas (OR 1.96, p < 0.01). Pediatric TBI was less likely to be associated with contusion, subdural hematoma, subarachnoid hemorrhage, or compression of the basal cisterns (p < 0.05). Rotterdam CT scores were significantly lower in the pediatric population (2.3 vs 2.6, p < 0.001). Conclusions There are significant differences in the CT findings in pediatric versus adult TBI, despite statistical similarities with regard to clinical severity of injury as measured by the GCS. These differences may be due to anatomical characteristics, the biomechanics of injury, and/or differences in injury mechanisms between pediatric and adult patients. The unique characteristics of pediatric TBI warrant consideration when formulating a clinical trial design or predicting functional outcome using prognostic models developed from adult TBI data.

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A systematic review of differences between brain temperature and core body temperature in adult patients with severe traumatic brain injury

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/01938924-201210240-00001 ◽

2012 ◽

Vol 10 (24) ◽

pp. 1410-1451

Author(s):

Kueh Wern Lunn ◽

Charmaine Childs

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Body Temperature ◽

Severe Traumatic Brain Injury ◽

Brain Temperature ◽

Core Body Temperature ◽

Adult Patients ◽

Core Body

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Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1728989 ◽

2021 ◽

Author(s):

Gopal Krishna ◽

Varun Aggarwal ◽

Ishwar Singh

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Clinical Outcome ◽

Road Traffic ◽

Statistical Significance ◽

Platelet Counts ◽

Coagulation Abnormalities ◽

The Mean ◽

D Dimer

Abstract Introduction Traumatic brain injury (TBI) affects the coagulation pathway in a distinct way than does extracranial trauma. The extent of coagulation abnormalities varies from bleeding diathesis to disseminated thrombosis. Design Prospective study. Methods The study included 50 patients of isolated TBI with cohorts of moderate (MHI) and severe head injury (SHI). Coagulopathy was graded according to the values of parameters in single laboratory. The incidence of coagulopathy according to the severity of TBI and correlation with disseminated intravascular coagulation (DIC) score, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen was observed. The comparison was also made between expired and discharged patients within each group. It also compared coagulation derailments with clinical presentation (Glasgow Coma Scale [GCS]) and outcome (Glasgow Outcome Scale [GOS]). Results Road traffic accident was the primary (72%) mode of injury. Fifty-two percent had MHI and rest had SHI. Eighty-four percent of cases were managed conservatively. The mean GCS was 12.23 and 5.75 in MHI and SHI, respectively. Sixty-two percent of MHI and 96% of the patients with SHI had coagulation abnormalities. On statistical analysis, DIC score (p < 0.001) strongly correlated with the severity of head injury and GOS. PT and APTT were also significantly associated with the severity of TBI. In patients with moderate TBI, D-dimer and platelet counts showed association with clinical outcome. Fibrinogen levels did not show any statistical significance. The mean platelet counts remained normal in both the groups of TBI. The mean GOS was 1.54 and 4.62 in SHI and MHI, respectively. Conclusion Coagulopathy is common in isolated TBI. The basic laboratory parameters are reliable predictors of coagulation abnormalities in TBI. Coagulopathy is directly associated with the severity of TBI, GCS, and poor outcome.

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Reply to Comment on Tsai, Y.-C., et al. Association of Stress-Induced Hyperglycemia and Diabetic Hyperglycemia with Mortality in Patients with Traumatic Brain Injury: Analysis of a Propensity Score-Matched Population. Int. J. Environ. Res. Public Health 2020, 17, 4266

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052531 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2531

Author(s):

Yu-Chin Tsai ◽

Shao-Chun Wu ◽

Ting-Min Hsieh ◽

Hang-Tsung Liu ◽

Chun-Ying Huang ◽

...

Keyword(s):

Public Health ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Propensity Score ◽

Brain Injuries ◽

Traumatic Brain Injuries ◽

Injury Analysis

Thank you for Eduardo Mekitarian Filho’s appreciation of our work on the study of stress-induced hyperglycemia (SIH) and diabetic hyperglycemia (DH) in patients with traumatic brain injuries [...]

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