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Coagulopathy in pediatric abusive head trauma
K P Hymel1, T C Abshire, D W Luckey
1Department of Pediatrics, School of Medicine, University of Colorado Health Sciences Center, Denver, USA.
Pediatrics
|March 1, 1997
Summary
Coagulopathy, including prothrombin time (PT) prolongation and activated coagulation, is frequent in pediatric abusive head trauma. Parenchymal brain damage significantly increases the likelihood of these coagulation defects.
Area of Science:
- Pediatric Traumatology
- Hematology
- Neurology
Background:
- Coagulopathy can be a complication of head trauma, potentially linked to parenchymal brain damage.
- Abusive head trauma (AHT) in children presents unique diagnostic challenges.
Purpose of the Study:
- To determine the frequency of coagulation defects in pediatric AHT.
- To investigate the association between coagulation abnormalities and parenchymal brain damage in AHT.
Main Methods:
- Retrospective review of 147 pediatric patients hospitalized for head trauma with validated AHT and coagulation screening within 48 hours.
- Nonparametric analysis comparing coagulation test results between patients with and without parenchymal brain damage.
Main Results:
- Prothrombin time (PT) prolongation occurred in 54% of AHT patients with parenchymal brain damage versus 20% without.
- Among deceased AHT patients with parenchymal brain damage, 94% had PT prolongation and 63% showed activated coagulation.
- Coagulation abnormalities are common in pediatric AHT, particularly with parenchymal brain damage.
Conclusions:
- PT prolongation and activated coagulation are frequent complications of pediatric AHT.
- In AHT with parenchymal brain damage, coagulation abnormalities are unlikely to be due to pre-existing conditions.
- Findings have implications for diagnosis, prognosis, and legal considerations in pediatric abusive head trauma cases.
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