Coagulopathy predicts poor outcome following head injury in children less than 16 years of age.
The authors examined the relationship between fibrin degradation products (FDP) and outcome in children with isolated head injury by reviewing the records of 69 children who met the following criteria: (1) less than 16 years of age; (2) diagnosis of isolated head injury and (3) FDP levels. Outcome was evaluated using the following Glasgow Outcome Scale (GOS): 1 = death; 2 = vegetative state; 3 = functionally impaired; 4 = minimal dysfunction; 5 = premorbid level of functioning. Poor outcome was defined as GOS 1-3. Twenty-nine of 33 patients with FDP > 1000 (g/mL had GOS scores < 4 compared to 4/36 patients (11%) with FDP < 1000 microg/mL (Fisher's Exact Probability Test P < .0001). When stratified by GCS, no other prognosticator of outcome was needed when GCS was < 7 and > 12. In patients with GCS 7-12, however, 4/6 with FDP >1000 microg/mL had a poor outcome and all 12 patients with FDP < 1000 microg/mL had a good outcome (P = .004). The authors conclude that FDP > 1000 microg/mL predicts poor outcome in children with isolated head injury. Fibrin degradation products are a strong independent prognosticator of outcome in children when GCS is between 7 and 12.
Vavilala
M S
MS
Department of Anesthesiology, Harborview Medical Center, University of Washington, Seattle 98104-2499, USA.
Dunbar
P J
PJ
Rivara
F P
FP
Lam
A M
AM
D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers; D001778:Blood Coagulation Disorders / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000097:blood* / Q000150:complications / Q000628:therapy*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products