title: Serum D-dimer concentrations are increased after pediatric traumatic brain injury.
abstract: OBJECTIVE
  To determine whether D-dimer would be increased in children with traumatic brain injury (TBI), specifically mild abusive head trauma.
  
  
  METHODS
  D-dimer was measured using multiplex bead technology in 195 children <4 years old (n = 93 controls without TBI, n = 102 cases with TBI) using previously collected serum. D-dimer was then measured prospectively in a clinical setting in 44 children (n = 24 controls, n = 20 cases). Receiver operator curves were generated for prospective data.
  
  
  RESULTS
  In both the retrospective and prospective cohorts, median (25th-75th percentile) D-dimer was significantly higher in cases vs controls. A receiver operator curve demonstrated an area under the curve of 0.91 (95% CI 0.83-0.99) in the prospective cohort. At a cut-off of 0.59 μg/L, the sensitivity and specificity for identification of a case was 90% and 75%, respectively.
  
  
  CONCLUSIONS
  Our data suggest that serum D-dimer may be able to be used to identify which young children at risk for abusive head trauma might benefit from a head computed tomography or other additional evaluation. Additional data are needed to better identify the clinical scenarios that may result in false positive or false negative D-dimer concentrations.
authors.affiliation: Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA; Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), University of Pittsburgh, Pittsburgh, PA. Electronic address: rachel.berger@chp.edu.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Berger
authors.affiliation: Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), University of Pittsburgh, Pittsburgh, PA.
authors.forename: Janet
authors.initials: J
authors.lastname: Fromkin
authors.affiliation: Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC), University of Pittsburgh, Pittsburgh, PA.
authors.forename: Pam
authors.initials: P
authors.lastname: Rubin
authors.affiliation: UPMC Hillman Cancer Center, Pittsburgh, PA.
authors.forename: John
authors.initials: J
authors.lastname: Snyder
authors.affiliation: Statistical Analysis and Measurement Consultants, Inc, Lanexa, VA.
authors.forename: Rudolph
authors.initials: R
authors.lastname: Richichi
authors.affiliation: Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kochanek
mesh_terms: D001930:Brain Injuries / Q000097:blood* / Q000209:etiology*; D016022:Case-Control Studies; D002649:Child Abuse / Q000175:diagnosis*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D