Early Coagulopathy in Pediatric Traumatic Brain Injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) Retrospective Study

作者全名："Chong, Shu-Ling; Ong, Gene Yong-Kwang; Zheng, Charles Qishi; Dang, Hongxing; Ming, Meixiu; Mahmood, Maznisah; Chan, Lawrence Chi Ngong; Chuah, Soo Lin; Lee, Olive Pei Ee; Qian, Suyun; Fan, Lijia; Konoike, Yoshihiko; Lee, Jan Hau"

作者地址："[Chong, Shu-Ling; Ong, Gene Yong-Kwang] KK Womens & Childrens Hosp, Dept Emergency Med, 100 Bukit Timah Rd, Singapore 229899, Singapore; [Chong, Shu-Ling; Ong, Gene Yong-Kwang; Lee, Jan Hau] Duke NUS Med Sch, Singapore, Singapore; [Zheng, Charles Qishi] Singapore Clin Res Inst, Singapore, Singapore; [Dang, Hongxing] Chongqing Med Univ, Dept Pediat Intens Care Unit, Childrens Hosp, Chongqing, Peoples R China; [Ming, Meixiu] Fudan Univ, Dept Pediat Intens Care Unit, Childrens Hosp, Shanghai, Peoples R China; [Mahmood, Maznisah] Inst Paediat, Dept Paediat, Kuala Lumpur, Malaysia; [Chan, Lawrence Chi Ngong] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Paediat, Hong Kong, Peoples R China; [Chuah, Soo Lin] Univ Malaya, Dept Paediat, Kuala Lumpur, Malaysia; [Lee, Olive Pei Ee] Sarawak Gen Hosp, Dept Paediat, Sarawak, Malaysia; [Qian, Suyun] Capital Med Univ, Beijing Childrens Hosp, Natl Ctr Childrens Hlth, Pediat Intens Care Unit, Beijing, Peoples R China; [Fan, Lijia] Natl Univ Singapore Hosp, Khoo Teck Puat Natl Univ Childrens Med Inst, Singapore, Singapore; [Fan, Lijia] Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Paediat, Singapore, Singapore; [Konoike, Yoshihiko] Hyogo Prefectural Kobe Childrens Hosp, Dept Pediat Crit Care Med, Kobe, Hyogo, Japan; [Lee, Jan Hau] KK Womens & Childrens Hosp, Childrens Intens Care Unit, Singapore, Singapore"

通信作者："Chong, SL (corresponding author), KK Womens & Childrens Hosp, Dept Emergency Med, 100 Bukit Timah Rd, Singapore 229899, Singapore."

来源：NEUROSURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000685210900036

JCR分区：Q1

影响因子：4.8

年份：2021

卷号：89

期号：2

开始页：283

结束页：290

文献类型：Article

关键词：Blood coagulation disorders; Brain injuries; Traumatic; Child; Mortality; Critical care outcomes

摘要："BACKGROUND: Although early coagulopathy increases mortality in adults with traumatic brain injury (TBI), less is known about pediatric TBI. OBJECTIVE: To describe the prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet levels of children with moderate to severe TBI to identify predictors of early coagulopathy and study the association with clinical outcomes. METHODS: Using the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) TBI retrospective cohort, we identified patients <16 yr old with a Glasgow Coma Scale (GCS) <= 13. We compared PT, APTT, platelets, and outcomes between children with isolated TBI and multiple trauma with TBI. We performed logistic regressions to identify predictors of early coagulopathy and study the association with mortality and poor functional outcomes. RESULTS: Among 370 children analyzed, 53/370 (14.3%) died and 127/370 (34.3%) had poor functional outcomes. PT was commonly deranged in both isolated TBI (53/173, 30.6%) and multiple trauma (101/197, 51.3%). Predictors for early coagulopathy were young age (adjusted odds ratio [aOR] 0.94, 95% CI 0.88-0.99, P = .023), GCS < 8 (aOR 1.96, 95% CI 1.26-3.06, P = .003), and presence of multiple trauma (aOR 2.21, 95% confidence interval [CI] 1.37-3.60, P = .001). After adjusting for age, gender, GCS, multiple traumas, and presence of intracranial bleed, children with early coagulopathy were more likely to die (aOR 7.56, 95% CI 3.04-23.06, P < .001) and have poor functional outcomes (aOR 2.16, 95% CI 1.26-3.76, P = .006). CONCLUSION: Early coagulopathy is common and independently associated with death and poor functional outcomes among children with TBI."

基金机构：SingHealth Foundation Research GrantSingHealth [SHF/FG670P/2017]

基金资助正文：This study was funded by SingHealth Foundation Research Grant (Grant Number SHF/FG670P/2017).