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Fall of platelet count in children with traumatic brain injury: is it of value?
Hosam-Mustafa Kamal1, Habeeb Sammou, Ahmad-Adnan Mardini
1Department of Pediatric Intensive Care Unit, King Fahad Hofuf Hospital, Hofuf, Saudi Arabia.
Insights
The percentage fall of platelet count (PFP) in children with traumatic brain injury (TBI) can predict clinical severity and outcome. Higher PFP indicates a poorer prognosis, making it a valuable tool for assessing TBI severity.
Area of Science:
- Pediatric Intensive Care
- Neurotrauma
- Hematology
Background:
- Traumatic brain injury (TBI) is a leading cause of death and disability in young individuals.
- Early prediction of TBI severity and patient outcomes is crucial for timely intervention.
Purpose of the Study:
- To evaluate the percentage fall of platelet count (PFP) as a predictor of clinical severity and outcome in children with TBI.
- To assess the relationship between PFP and TBI severity, Glasgow Coma Scale (GCS) scores, and patient outcomes.
Main Methods:
- A cohort of 74 pediatric patients with TBI admitted to the Pediatric Intensive Care Unit (PICU) was studied.
- Platelet counts were monitored, and the percentage fall of platelet count (PFP) was calculated.
- Injury severity was assessed using the Glasgow Coma Scale (GCS), and outcomes were categorized as poor or favorable.
Main Results:
- PFP was significantly higher in patients with poor outcomes (56.0%) compared to those with favorable outcomes (25.3%).
- PFP correlated strongly with TBI severity, GCS scores, clinical outcome, and length of stay.
- Thrombocytopenia was more frequent in poor outcome patients, with PFP at 51.5% identified as an optimal cutoff for predicting poor outcomes.
Conclusions:
- The percentage fall of platelet count (PFP) is a significant independent predictor of clinical severity and outcome in pediatric traumatic brain injury.
- Increased PFP is associated with more severe TBI and poorer patient prognosis.
Objective:
Trauma is the leading cause of mortality and morbidity among young age groups in Saudi Arabia and developed countries. This study aimed to evaluate the fall of platelet count in children with traumatic brain injury (TBI) as a potential predictor for clinical severity and outcome.
Methods:
Totally 74 patients with TBI were admitted to the Pediatric Intensive Care Unit (PICU) of our hospital from the beginning of January 2008 to the end of March 2010 (27 months). Baseline enrolling criteria were age less than or equal to 12 years, admission within 4 hours after trauma event, and abbreviated injury scale (AIS) less than 3 for extracranial injuries. Injury severity was classified as mild, moderate and severe according to their Glasgow Coma Scale (GCS) scores. Clinical outcomes at discharge were defined as poor (death, severe neurological morbidity) and favorable (moderate disability and good recovery). Platelet count was taken 2-3 times on the first day after admission and thereafter once daily. The percentage fall of platelet count (PFP) was calculated and taken as an index of change. PFP was considered zero if the platelet count was higher than the initial value.
Results:
PFP was significantly higher in patients with poor outcomes (mean 56.0%+/-3.8%, median 55.5%) compared to those with favorable outcomes (mean 25.3%+/-3.2%, median 20.5%, P less than 0.01). PFP was also closely related to the severity of TBI, GCS score, clinical outcome and length of stay for survivors (P less than 0.01 for each). The frequency of thrombocytopenia was significantly higher in poor outcome patients than in favorable outcome patients (P less than 0.05). The validity of thrombocytopenia as a risk factor to predict poor outcome after TBI was: specificity, 77.4%; odd ratio (OR), 3.1; relative risk (RR), 2.15. Receiver operating characteristic (ROC) curve and Youden index showed that the optimum cutoff point of PFP was at 51.5%.
Conclusion:
PFP is increased with the severity of TBI and it can be taken as a significant independent predicting factor for its outcome as well.
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