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Updated: Jul 26, 2026
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
Relationship between admission coagulopathy and prognosis in children with traumatic brain injury: a retrospective
Cheng-Yan You1,2,3,4,5, Si-Wei Lu1,2,3,4,5, Yue-Qiang Fu6,7,8,9,10
1Department of Critical Care Medicine, Children's Hospital, Chongqing Medical University, 136# Zhongshan Er Road, Yu Zhong District, 400014, Chongqing, People's Republic of China.
Insights
Coagulopathy in pediatric traumatic brain injury (TBI) is linked to poor outcomes. Elevated activated partial thromboplastin time (APTT) and low fibrinogen levels at admission predict mortality in children with TBI.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma
- Hematology
Background:
- Coagulopathy is a known predictor of poor outcomes in adult traumatic brain injury (TBI).
- Limited research exists on coagulopathy specifically in pediatric TBI cases.
- Understanding these associations is crucial for improving pediatric TBI patient prognosis.
Purpose of the Study:
- To evaluate the impact of admission coagulopathy on prognosis in pediatric patients with moderate to severe TBI.
- To identify specific coagulation parameters that predict mortality risk.
- To stratify death risk using classification and regression tree (CART) analysis.
Main Methods:
- Retrospective analysis of 281 children with TBI (Glasgow Coma Scale ≤13) from April 2012 to December 2019.
- Classification and regression tree (CART) analysis to stratify mortality risk based on coagulation parameters.
- Multivariate logistic regression to examine the importance of coagulation parameters.
Main Results:
- Activated partial thromboplastin time (APTT) and fibrinogen were identified as effective predictors of in-hospital mortality.
- CART analysis revealed APTT > 39.2 s as the primary discriminator, with fibrinogen ≤ 120 mg/dL as a secondary factor.
- Mortality rates varied significantly based on APTT and fibrinogen levels: 4.5% (low APTT, high fibrinogen), 20.5% (low APTT, low fibrinogen), and 60.8% (high APTT).
- Prolonged ICU stay and mechanical ventilation were associated with abnormal APTT or fibrinogen values.
- APTT > 39.2 s and fibrinogen ≤ 120 mg/dL were independently associated with mortality in pediatric TBI.
Conclusions:
- Admission APTT > 39.2 s and fibrinogen ≤ 120 mg/dL are independent predictors of mortality in children with moderate to severe TBI.
- Early identification and intervention for abnormal APTT and fibrinogen levels may improve outcomes for pediatric TBI patients.
- These findings highlight the importance of monitoring coagulation status in pediatric TBI management.
Background:
Coagulopathy in adult patients with traumatic brain injury (TBI) is strongly associated with unfavorable outcomes. However, few reports focus on pediatric TBI-associated coagulopathy.
Methods:
We retrospectively identified children with Glasgow Coma Scale ≤ 13 in a tertiary pediatric hospital from April 2012 to December 2019 to evaluate the impact of admission coagulopathy on their prognosis. A classification and regression tree (CART) analysis using coagulation parameters was performed to stratify the death risk among patients. The importance of these parameters was examined by multivariate logistic regression analysis.
Results:
A total of 281 children with moderate to severe TBI were enrolled. A receiver operating characteristic curve showed that activated partial thromboplastin time (APTT) and fibrinogen were effective predictors of in-hospital mortality. According to the CART analysis, APTT of 39.2 s was identified as the best discriminator, while 120 mg/dL fibrinogen was the second split in the subgroup of APTT ≤ 39.2 s. Patients were stratified into three groups, in which mortality was as follows: 4.5 % (APTT ≤ 39.2 s, fibrinogen > 120 mg/dL), 20.5 % (APTT ≤ 39.2 s and fibrinogen ≤ 120 mg/dL) and 60.8 % (APTT > 39.2 s). Furthermore, length-of-stay in the ICU and duration of mechanical ventilation were significantly prolonged in patients with deteriorated APTT or fibrinogen values. Multiple logistic regression analysis showed that APTT > 39.2 s and fibrinogen ≤ 120 mg/dL was independently associated with mortality in children with moderate to severe TBI.
Conclusions:
We concluded that admission APTT > 39.2 s and fibrinogen ≤ 120 mg/dL were independently associated with mortality in children with moderate to severe TBI. Early identification and intervention of abnormal APTT and fibrinogen in pediatric TBI patients may be beneficial to their prognosis.
