Related Experiment Video
Updated: Jan 3, 2026
Use of a Wireless Video-EEG System to Monitor Epileptiform Discharges Following Lateral Fluid-Percussion Induced Traumatic Brain Injury
Published on: June 21, 2019
Low plasma D-dimer predicts absence of intracranial injury and skull fracture
Masahiro Nozawa1, Hiroki Mishina2, Satoshi Tsuji1
1Emergency Service and Transport Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan.
Insights
Low plasma D-dimer levels can safely rule out intracranial injury or skull fractures in children with head trauma, reducing the need for CT scans.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Biomarkers
Background:
- Intracranial injury (ICI) is a significant cause of childhood morbidity.
- Computed tomography (CT) carries risks for children undergoing evaluation for ICI.
- Plasma D-dimer shows potential in identifying or excluding ICI.
Purpose of the Study:
- To assess the diagnostic performance of plasma D-dimer in ruling out ICI or skull fracture (SF) in pediatric head trauma patients.
- To determine the utility of D-dimer testing in reducing CT utilization in children.
Main Methods:
- Cross-sectional study of 364 children (0-16 years) with head trauma treated in an Emergency Department.
- Evaluated sensitivity, specificity, PPV, and NPV of plasma D-dimer (cut-off ≤0.5 μg/mL) against CT findings.
- Analysis stratified by age (<2 years and ≥2 years).
Main Results:
- Abnormal CT findings (ICI/SF) were present in 33.8% of children.
- Plasma D-dimer demonstrated 100% sensitivity and 100% NPV for detecting ICI/SF.
- High sensitivity and NPV were maintained across different age groups.
Conclusions:
- A low plasma D-dimer level (≤0.5 μg/mL) effectively excludes traumatic intracranial injury or skull fractures in children.
- Plasma D-dimer can be a valuable tool to limit unnecessary CT scans in pediatric head trauma evaluations.
Background:
Intracranial injury (ICI) is a leading cause of morbidity in children; however, the use of computed tomography (CT) to evaluate ICI has significant risks in children. A recent study suggests D-dimer is associated with ICI. We surveyed the performance of plasma D-dimer in ruling out ICI or skull fracture (SF) in children with head trauma.
Methods:
In a cross-sectional study in the Emergency Department (ED) at the National Center for Child Health and Development in Tokyo, Japan we reviewed the medical records of all children age 0-16 years brought to the ED with head trauma from January 2010 to July 2013, who underwent CT based on established clinical criteria and had plasma D-dimer measured. We evaluated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of plasma D-dimer, using abnormal findings on CT (ICI, SF) as the criterion standard. We repeated analysis after stratification by age (<2 years, ≥2 years).
Results:
Among 364 eligible children (112 children <2 year of age), abnormal findings on CT were demonstrated in 33.8% (123/364). With the cut-off set at 0.5 μg/mL, sensitivity was 100.0% (95% confidence interval [CI]: 95.6-100.0%), specificity 34.0% (95%CI: 28.1-40.4%), PPV 43.6% (95%CI: 37.7-49.6%), NPV 100.0% (95%CI: 93.5-100%). After stratification by age (<2 years and ≥2 years), sensitivity (100.0% and 100.0%) and NPV (100.0% and 100.0%) remained high in both age groups.
Conclusions:
Low plasma D-dimer (≤0.5 μg/mL) is useful to limit the use of CT in children by excluding traumatic ICI or SF.
