TY - JOUR
T1 - Glasgow Coma Scale as a predictor for hemocoagulative disorders after blunt pediatric traumatic brain injury*
AU - Peiniger, Sigune
AU - Nienaber, Ulrike
AU - Lefering, Rolf
AU - Braun, Maximilian
AU - Wafaisade, Arasch
AU - Borgman, Matthew A.
AU - Spinella, Philip C.
AU - Maegele, Marc
PY - 2012/7
Y1 - 2012/7
N2 - OBJECTIVE: Coagulopathy is a complication of traumatic brain injury and its presence after injury has been identified as a risk factor for prognosis. It was our aim to determine whether neurologic findings reflected by Glasgow Coma Scale at initial resuscitation can predict hemocoagulative disorders resulting from traumatic brain injury that may aggravate clinical sequelae and outcome in children. DESIGN: A retrospective analysis of 200 datasets from children with blunt, isolated traumatic brain injury documented in the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie was conducted. Inclusion criteria were primary admission, age <14 yrs, and sustained isolated blunt traumatic brain injury. SETTING: Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie-affiliated trauma centers in Germany. PATIENTS: Two hundred datasets of children (age <14 yrs) with blunt isolated traumatic brain injury were analyzed: children were subdivided into two groups according to Glasgow Coma Scale at the scene (Glasgow Coma Scale ≤8 vs. Glasgow Coma Scale >8) and reviewed for coagulation abnormalities upon emergency room admission and outcome. MEASUREMENT AND MAIN RESULTS: Fifty-one percent (n = 102 of 200) of children had Glasgow Coma Scale >8 and 49% (n = 98 of 200) had Glasgow Coma Scale ≤8 at the scene. The incidence of coagulopathy at admission was higher in children with Glasgow Coma Scale ≤8 compared to children with Glasgow Coma Scale >8: 44% (n = 31 of 71) vs. 14% (n = 11 of 79) (p < .001). Multivariate logistic regression revealed that Glasgow Coma Scale ≤8 at scene was associated with coagulopathy at admission (odds ratio 3.378, p = .009) and stepwise regression identified Glasgow Coma Scale ≤8 as an independent risk factor for coagulopathy. Mortality in children with Glasgow Coma Scale ≤8 at scene was substantially higher with the presence of coagulation abnormalities at admission compared to children in which coagulopathy was absent (51.6%, n = 16 of 31 vs. 5% n = 2 of 40). CONCLUSIONS: Glasgow Coma Scale ≤8 at scene in children with isolated traumatic brain injury is associated with increased risk for coagulopathy and mortality. These results may guide laboratory testing, management, and blood bank resources in acute pediatric trauma care.
AB - OBJECTIVE: Coagulopathy is a complication of traumatic brain injury and its presence after injury has been identified as a risk factor for prognosis. It was our aim to determine whether neurologic findings reflected by Glasgow Coma Scale at initial resuscitation can predict hemocoagulative disorders resulting from traumatic brain injury that may aggravate clinical sequelae and outcome in children. DESIGN: A retrospective analysis of 200 datasets from children with blunt, isolated traumatic brain injury documented in the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie was conducted. Inclusion criteria were primary admission, age <14 yrs, and sustained isolated blunt traumatic brain injury. SETTING: Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie-affiliated trauma centers in Germany. PATIENTS: Two hundred datasets of children (age <14 yrs) with blunt isolated traumatic brain injury were analyzed: children were subdivided into two groups according to Glasgow Coma Scale at the scene (Glasgow Coma Scale ≤8 vs. Glasgow Coma Scale >8) and reviewed for coagulation abnormalities upon emergency room admission and outcome. MEASUREMENT AND MAIN RESULTS: Fifty-one percent (n = 102 of 200) of children had Glasgow Coma Scale >8 and 49% (n = 98 of 200) had Glasgow Coma Scale ≤8 at the scene. The incidence of coagulopathy at admission was higher in children with Glasgow Coma Scale ≤8 compared to children with Glasgow Coma Scale >8: 44% (n = 31 of 71) vs. 14% (n = 11 of 79) (p < .001). Multivariate logistic regression revealed that Glasgow Coma Scale ≤8 at scene was associated with coagulopathy at admission (odds ratio 3.378, p = .009) and stepwise regression identified Glasgow Coma Scale ≤8 as an independent risk factor for coagulopathy. Mortality in children with Glasgow Coma Scale ≤8 at scene was substantially higher with the presence of coagulation abnormalities at admission compared to children in which coagulopathy was absent (51.6%, n = 16 of 31 vs. 5% n = 2 of 40). CONCLUSIONS: Glasgow Coma Scale ≤8 at scene in children with isolated traumatic brain injury is associated with increased risk for coagulopathy and mortality. These results may guide laboratory testing, management, and blood bank resources in acute pediatric trauma care.
KW - Children
KW - Glasgow Coma Scale
KW - Hemocoagulative disorders
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=84864287333&partnerID=8YFLogxK
U2 - 10.1097/PCC.0b013e31823893c5
DO - 10.1097/PCC.0b013e31823893c5
M3 - Article
C2 - 22422166
AN - SCOPUS:84864287333
SN - 1529-7535
VL - 13
SP - 455
EP - 460
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 4
ER -