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Glasgow Coma Scale predicts coagulopathy in pediatric trauma patients
M S Keller1, D G Fendya, T R Weber
1Department of Surgery, Cardinal Glennon Children's Hospital, 1465 South Grand Boulevard, St Louis, MO 63104-1095, USA.
Insights
Neurologic findings in head-injured children predict coagulation issues. A normal Glasgow Coma Scale (GCS) score at presentation excludes significant coagulopathy, while a low GCS indicates risk.
Area of Science:
- Pediatric Traumatology
- Neurology
- Hematology
Background:
- Head injuries in children can lead to complex complications.
- Assessing neurologic status is crucial for guiding immediate medical interventions.
- Coagulation abnormalities are a significant concern in pediatric head trauma.
Purpose of the Study:
- To investigate the predictive value of initial neurologic findings, specifically the Glasgow Coma Scale (GCS), for coagulation abnormalities in pediatric head injury.
- To establish correlations between GCS scores and laboratory coagulation parameters (PT, INR, PTT) and the need for fresh frozen plasma (FFP).
Main Methods:
- Retrospective review of 53 pediatric patients with head injuries.
- Data collected included Glasgow Coma Scale (GCS) scores, prothrombin time (PT), international normalized ratio (INR), partial thromboplastin time (PTT), fresh frozen plasma (FFP) use, and outcomes.
- Analysis compared neurologic status (GCS 15 vs. GCS < 14) with the incidence of intracranial injury and coagulation abnormalities.
Main Results:
- Children with a GCS < 14 had a significantly higher incidence of intracranial injury (78%) compared to those with GCS 15 (12%).
- Abnormal coagulation was observed in 67% of children with GCS < 14 versus 7% with GCS 15.
- Children with GCS < 14 required fresh frozen plasma (FFP), while those with GCS 15 and intracranial injury did not.
Conclusions:
- A normal Glasgow Coma Scale (GCS) score of 15 at presentation effectively rules out significant coagulation abnormalities in pediatric head injury.
- Children with a GCS < 14 are at increased risk for intracranial injury and coagulopathy, with risk inversely proportional to GCS.
- Preparation of fresh frozen plasma (FFP) is recommended for children presenting with a GCS < 8 to manage potential coagulopathy during trauma resuscitation.
Abstract:
The aim of this study was to determine if neurologic findings at the time of initial resuscitation can predict coagulation abnormalities resulting from head injury. Fifty-three children with head injury were reviewed for Glasgow Coma Scale (GCS), prothrombin time (PT), international normalized ratio (INR), partial thromboplastin time (PTT), use of fresh frozen plasma (FFP) and outcome. Twenty-six of the 53 children (49%) presented with a GCS of 15 and 27 (51%) had a GCS less than 14. The incidence of computed tomography (CT)-documented intracranial injury was 12% in those children with a GCS of 15 versus 78% when GCS < or = 14 (P < .05). Abnormal coagulation (PT > 14.5, INR > 1.2, PTT > 38) in children with a GCS = 15 was 7% v 67% when GCS was < or = 14 (P < .05). A mean of 1 unit of FFP per patient was required in children with a GCS of < or = 14. No child with GCS of 15 and CT evidence for intracranial injury had a coagulopathy, and no child with GCS of 15 required FFP. In head injured children, significant coagulation abnormalities requiring treatment are excluded by the presence of a normal GCS at presentation. Children with GCS less than 14 are at risk for intracranial injury and coagulopathy, this risk increases inversely with the GCS. Children who present with a GCS less than 8 should have FFP prepared at the time of admission. These data may guide the use of laboratory tests and blood bank resources during trauma resuscitation.