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Coagulopathy after isolated severe traumatic brain injury in children

Peep Talving1, Thomas Lustenberger, Lydia Lam

  • 1Division of Acute Care Surgery, Department of Surgery, Keck School of Medicine, Los Angeles County + University of Southern California Medical Center, Los Angeles, California 90033-4525, USA. peep.talving@surgery.usc.edu

The Journal of Trauma
|March 24, 2011
PubMed

Insights

Severe traumatic brain injury (sTBI) is common in children, with nearly 40% experiencing coagulopathy. Factors like head injury severity and brain contusions are linked to this condition.

Area of Science:

  • Pediatric Traumatology
  • Neurocritical Care
  • Hematology

Background:

  • Severe traumatic brain injury (sTBI) in children is understudied regarding coagulopathy.
  • Coagulopathy significantly impacts patient outcomes.

Purpose of the Study:

  • To determine the incidence of sTBI-associated coagulopathy in pediatric patients.
  • To identify risk factors for sTBI coagulopathy in children.
  • To assess the impact of coagulopathy on in-hospital outcomes.

Main Methods:

  • Retrospective analysis of pediatric patients (<18 years) with isolated sTBI (head AIS ≥3).
  • Coagulopathy defined by thrombocytopenia, elevated INR, or prolonged aPTT.
  • Analysis of incidence, risk factors, and in-hospital outcomes.

Main Results:

  • 42.8% of pediatric sTBI patients developed coagulopathy.
  • Incidence increased with head injury severity (AIS score).
  • Independent risk factors included low GCS, increasing age, ISS ≥16, and brain contusions.

Conclusions:

  • Pediatric sTBI-associated coagulopathy is highly prevalent (approx. 40%) and linked to injury severity.
  • Low GCS, older age, high ISS, and intraparenchymal lesions are associated with coagulopathy.
  • While coagulopathy is common, it did not significantly impact mortality in this cohort after adjustment.
Abstract

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