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The Glasgow Outcome Scale-Extended Pediatric Scores of Intracranial Bleeding Patients with Acquired Prothrombin
1Surgery Department, Medical Faculty of Universitas Kristen Indonesia, Jakarta, Indonesia, robertsinurat@yahoo.com.
Insights
Surgical evacuation for pediatric intracranial bleeding due to acquired prothrombin complex deficiency (APCD) can lead to good recovery. Most patients showed improved Glasgow Coma Scale scores and positive outcomes on the GOS-ePed scale after craniotomy and duraplasty.
Area of Science:
- Pediatric Neurosurgery
- Hematology
- Critical Care Medicine
Background:
- Acquired prothrombin complex deficiency (APCD) in pediatric patients can necessitate surgical intervention for intracranial bleeding.
- Craniotomy and duraplasty are life-saving procedures when conservative management fails and brain herniation is imminent.
Purpose of the Study:
- To evaluate the Glasgow Outcome Scale-Extended Pediatric (GOS-ePed) score in pediatric patients with intracranial bleeding due to APCD following craniotomy and duraplasty.
- To assess the effectiveness of surgical evacuation in improving neurological outcomes.
Main Methods:
- Retrospective study of pediatric patients undergoing craniotomy and duraplasty for intracranial bleeding secondary to APCD.
- Analysis of pre- and post-operative blood tests (hemoglobin, prothrombin time, activated prothrombin time, platelets) and Glasgow Coma Scale (GCS) scores.
- Outcome assessment using the GOS-ePed score.
Main Results:
- Five neonates with APCD and intracranial bleeding underwent surgery; all lacked vitamin K prophylaxis.
- Post-operative blood parameters normalized after vitamin K, packed red cells (PRCs), and fresh frozen plasma (FFP) transfusion (p < 0.05).
- Four out of five patients showed significant GCS improvement, with 80% achieving good recovery on the GOS-ePed scale.
Conclusions:
- Craniotomy and duraplasty for pediatric intracranial bleeding due to APCD can result in favorable neurological outcomes.
- The GOS-ePed score indicates a high likelihood of good recovery in these critically ill pediatric patients.
Introduction:
Surgical evacuation of intracranial bleeding in pediatric patients due to acquired prothrombin complex deficiency (APCD) is a life-saving surgery when conservative treatment insufficient and impending brain herniation. This study aimed to evaluate the Glasgow outcome scale-extended pediatric (GOS-ePed) score of the pediatric intracranial bleeding patients with APCD after craniotomy and duraplasty.
Method:
This was a retrospective study in the last 5 years of our experience. All of the pediatric patients with intracranial bleeding due to APCD who needed surgery were investigated. The data were collected from medical records after their parents have given their written informed concern and approved by the Ethics Review Committee, Faculty of Medicine, Universitas Kristen Indonesia. The inclusion criteria were patients who operated on by craniotomy and duraplasty. The patient with a second disease was excluded. Blood tests include hemoglobin, prothrombin time, activated prothrombin time, and platelets were investigated before and after intravenous vitamin K injection, transfusion packed red cells (PRCs), and fresh frozen plasma (FFP) administration. The Glasgow coma scale (GCS) pre- and postoperatively was evaluated using a modified GCS for infants and children. The outcome was evaluated by the GOS-ePed score. All data were analyzed with the normality test and paired t test.
Results:
There were 5 patients age between 37 and 60 days, and all patients did not get vitamin K prophylaxis after birth. The blood tests of all patients revealed anemia, prothrombin, and activated prothrombin time increased, but platelets were normal. All these values returned to normal after vitamin K injection, transfusion of PRCs, and FFP. The paired t tests were p < 0.05. The GCS of all patients before surgery was 8 or below. After surgery, the GCS of 4 patients was increased become 12 and 15. One patient did not change significantly. The GOS-ePed score showed 4 patients (80%) had upper or lower good recovery, and 1 patient (20%) was in a vegetative state.
Conclusions:
The GOS-ePed score of the pediatric intracranial bleeding with APCD after craniotomy and duraplasty was mostly in upper or lower good recovery.
