The influence of hemocoagulative disorders on the outcome of children with head injury.
BACKGROUND
Although disseminated intravascular coagulation (DIC) and other hemocoagulative abnormalities are severe complications of head injury, their effect on clinical outcome remains unclear, particularly among children.


OBJECTIVE
To evaluate the frequency of hemocoagulative abnormalities and their influence on outcome among children with head injury.


METHODS
We conducted a prospective observational study among 60 children with head injury, immediately evaluating severity of head injury (Glasgow Coma Scale, GCS); cerebral axial tomography; prothrombin time; activated partial thromboplastin time (aPTT); fibrinogen level; concentration of fibrin-fibrinogen degradation products (FDP), and platelet count. Two months after injury, we applied the Glasgow Outcome Score (GOS). Associations with GOS were evaluated using univariate and multivariate logistic models.


RESULTS
Among children with severe head injury, 22.2% (6/27) developed DIC, all of whom died and had shown severe brain edema. Among those with severe head injury yet without DIC, the mortality was only 14.2%. A low GOS was significantly and independently associated with a low GCS, multiple trauma, delayed aPTT, low fibrinogen level, elevated FDP and low platelet count. Brain edema was also associated with a low GOS, though not significantly.


CONCLUSIONS
In addition to GCS, type of trauma, type of brain lesion and certain coagulation abnormalities are predictors of GOS.
Chiaretti
A
A
Pediatric Intensive Care Unit, Catholic University Medical School, I-00168 Rome, Italy. chiarant@katamail.com
Pezzotti
P
P
Mestrovic
J
J
Piastra
M
M
Polidori
G
G
Storti
S
S
Velardi
F
F
Di Rocco
C
C
D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000209:etiology; D001930:Brain Injuries / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D019370:Observation; D011446:Prospective Studies; D016896:Treatment Outcome