Related Experiment Video
Updated: Jul 14, 2026
Determination of the Procoagulant Activity of Extracellular Vesicle (EV) Using EV-Activated Clotting Time (EV-ACT)
Published on: August 4, 2023
Coagulation disorder in children and adolescents with moderate to severe traumatic brain injury
Carolina A Affonseca1, Luís Fernando A Carvalho, Sérgio D Guerra
1Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. luiscarol@uol.com.br
Insights
Coagulopathy is common in children with severe traumatic brain injury, linked to injury severity but not directly to mortality. It serves as an important marker of injury severity in pediatric TBI patients.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma research
- Hematology
Background:
- Moderate to severe traumatic brain injury (TBI) is a significant cause of morbidity and mortality in children and adolescents.
- Coagulation disorders are a known complication of TBI, but their specific impact in pediatric populations requires further elucidation.
- Understanding the epidemiological profile and associated factors of coagulopathy in pediatric TBI is crucial for improving patient outcomes.
Purpose of the Study:
- To characterize the epidemiological profile of pediatric patients with moderate to severe TBI.
- To determine the frequency of coagulopathy in this patient group.
- To investigate the relationship between coagulopathy, trauma severity, and mortality in pediatric TBI.
Main Methods:
- A cross-sectional study was conducted on 301 pediatric patients (up to 16 years) admitted to the ICU with moderate to severe TBI.
- Coagulation profiles were analyzed in conjunction with clinical, epidemiological, and CT scan findings.
- Univariate and multivariate analyses were employed to assess associations between coagulopathy and mortality.
Main Results:
- Coagulopathy was present in approximately 77% of patients and was directly associated with trauma severity.
- Factors associated with coagulopathy included TBI severity, brain swelling on CT, and chest/abdominal injuries.
- Mortality was approximately 35%, with increased risk linked to hyponatremia, hypotension, and acute respiratory distress syndrome.
Conclusions:
- Coagulopathy is a frequent complication in pediatric patients with moderate to severe TBI.
- While not directly associated with increased mortality in this study, coagulopathy serves as a significant marker of injury severity.
- Further research may explore targeted interventions for coagulopathy in pediatric TBI.
Objectives:
To describe the epidemiological profile of children and adolescents with moderate to severe traumatic brain injury admitted to an intensive care unit; to describe the frequency of coagulation disorders in these patients; to determine the relationship between coagulopathy and trauma severity; to assess the factors associated with coagulopathy; and to assess the effect of coagulopathy on the mortality of these patients.
Methods:
Cross-sectional study with 301 patients aged up to 16 years admitted to an intensive care unit due to moderate to severe traumatic brain injury, carried out over a 5-year period. The coagulation profile was associated with clinical, epidemiological and CT findings. Univariate and multivariate analyses were used to check the association between coagulopathy and mortality.
Results:
Minimum age was 23 days, and maximum age was 16 years (mean of 7.9 years). About 77% of patients had coagulopathy, whose occurrence was directly associated with the severity of the trauma, but not with the rise in mortality. The factors associated with the presence of coagulopathy were the following: severity of the traumatic brain injury (OR=2.83; 95%CI 1.58-5.07), diagnosis of brain swelling on cranial computed tomography (OR=2.11; 95%CI 1.13-4.07) and occurrence of chest and/or abdominal injury (OR=2.07; 95%CI 1.11-4.00). Approximately 35% of patients died. The multivariate analysis showed that the factors associated with an increased risk of death were presence of sodium disorders (OR=5.56; 95%CI 2.90-10.65), hypotension in the intensive care unit (OR=12.58; 95%CI 4.40-35.00) and acute respiratory distress syndrome (OR=13.57; 95%CI 1.51-121.66).
Conclusion:
The development of coagulopathy is a frequent complication in patients with moderate to severe traumatic brain injury. Even though it is not closely associated with death in this study, it may be regarded as a marker of injury severity.
Related Concept Videos
01:24Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:28Traumatic Brain Injury l: Introduction
01:09Coagulation
During the coagulation phase, clotting factors, or procoagulants, play a vital role in initiating and progressing the coagulation cascade. This cascade is a series of reactions...
01:29Hemorrhagic Stroke ll: Pathophysiology
01:05Introduction to Hemostasis
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized, and...
01:20Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which forms a...