Plasma D-dimer as a Prognostic Marker in ICU Admitted Egyptian Children with Traumatic Brain Injury.
BACKGROUND
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. This study aimed at evaluation of the D-dimer blood levels as a new marker to predict prognosis and outcome of traumatic brain injuries among children.


METHODS
This case control study was conducted at the Paediatric Intensive Care Unit (ICU), Alharm Hospital in Giza, Egypt during 2012-2013, on 46 Paediatric cases admitted to ICU with head injury and 20 normal age-matched controls. Clinical data and venous blood samples were prospectively collected at 1(st), 3(rd) and 14(th) day of admission, in addition to examination finding as Glasgow coma scale (GCS), cranial brain computed tomography (CT), routine laboratory investigations (CBC, CRP, SGOT, SGPT, urea, creatinine, random blood glucose, Na, K and arterial blood gases) plasma D-dimer, INR, PT, aPTT and PC. Data analysis was carried out accordingly and ROC curve was performed to explore the discriminating ability of D-dimer through estimation of its accuracy in differentiating temporal survivorship of those with TBI.


RESULTS
Cases were classified according to outcome into survivors and non-survivors. Significant difference was observed between cases and controls and between survivors and non-survivors during 1(st), 3(rd) and 14(th) day of the follow up including GCS, blood levels of D-dimer, PT and aPTT. ROC curve analysis for D-dimer showed decline in both sensitivity from 89.5% to 73.7% and specificity from 100% to 81.5% along the study days respectively. D-dimer time measurements showed significant decline among survivors from 4.2 to 0.7, while in the non survivor group this decline was much higher from 27.9 to 1.4.


CONCLUSIONS
Low plasma D-dimer suggests the absence of brain injury, and good prognosis.
Faculty of Medicine, Department of Pediatrics, Cairo University , Egypt .
Hala Mohamed Amin
HM
Foaud
Faculty of Medicine, Department of Pediatrics, Cairo University , Egypt .
John Rene
JR
Labib
Faculty of Medicine, Department of Pediatrics, Cairo University , Egypt .
Hala Gabr
HG
Metwally
Student, Department of Pediatrics, Ministry of Health and Population , Egypt .
Khaled Mohamed Abd
KM
El-Twab
Biomarker; Brain injury; Children; D-dimer; Head trauma