title: Coagulopathy after isolated severe traumatic brain injury in children.
abstract: BACKGROUND
  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(3)) 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.
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, Los Angeles, California 90033-4525, USA. peep.talving@surgery.usc.edu
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Thomas
authors.initials: T
authors.lastname: Lustenberger
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Shahin
authors.initials: S
authors.lastname: Mohseni
authors.forename: David
authors.initials: D
authors.lastname: Plurad
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Green
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000401:mortality; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D019934:International Normalized Ratio; D016015:Logistic Models; D008297:Male; D010314:Partial Thromboplastin Time; D012189:Retrospective Studies; D012307:Risk Factors