Early coagulopathy in pediatric traumatic brain injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study
Although early coagulopathy increases mortality in adults with traumatic brain injury (TBI), less is known about pediatric TBI. OBJECTIVE: To describe the prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet levels of children with moderate to severe TBI to identify pred...
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my.um.eprints.344992022-06-13T06:50:35Z http://eprints.um.edu.my/34499/ Early coagulopathy in pediatric traumatic brain injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study Chong, Shu-Ling Ong, Gene Yong-Kwang Zheng, Charles Qishi Dang, Hongxing Ming, Meixiu Mahmood, Maznisah Chan, Lawrence Chi Ngong Chuah, Soo Lin Lee, Olive Pei Ee Qian, Suyun Fan, Lijia Konoike, Yoshihiko Lee, Jan Hau Asi, Pediat Acute Critical Care Med R Medicine RJ Pediatrics Although early coagulopathy increases mortality in adults with traumatic brain injury (TBI), less is known about pediatric TBI. OBJECTIVE: To describe the prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet levels of children with moderate to severe TBI to identify predictors of early coagulopathy and study the association with clinical outcomes. METHODS: Using the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) TBI retrospective cohort, we identified patients <16 yr old with a Glasgow Coma Scale (GCS) <= 13. We compared PT, APTT, platelets, and outcomes between children with isolated TBI and multiple trauma with TBI. We performed logistic regressions to identify predictors of early coagulopathy and study the association with mortality and poor functional outcomes. RESULTS: Among 370 children analyzed, 53/370 (14.3%) died and 127/370 (34.3%) had poor functional outcomes. PT was commonly deranged in both isolated TBI (53/173, 30.6%) and multiple trauma (101/197, 51.3%). Predictors for early coagulopathy were young age (adjusted odds ratio aOR] 0.94, 95% CI 0.88-0.99, P = .023), GCS < 8 (aOR 1.96, 95% CI 1.26-3.06, P = .003), and presence of multiple trauma (aOR 2.21, 95% confidence interval CI] 1.37-3.60, P = .001). After adjusting for age, gender, GCS, multiple traumas, and presence of intracranial bleed, children with early coagulopathy were more likely to die (aOR 7.56, 95% CI 3.04-23.06, P < .001) and have poor functional outcomes (aOR 2.16, 95% CI 1.26-3.76, P = .006). CONCLUSION: Early coagulopathy is common and independently associated with death and poor functional outcomes among children with TBI. Oxford Univ Press Inc 2021-08 Article PeerReviewed Chong, Shu-Ling and Ong, Gene Yong-Kwang and Zheng, Charles Qishi and Dang, Hongxing and Ming, Meixiu and Mahmood, Maznisah and Chan, Lawrence Chi Ngong and Chuah, Soo Lin and Lee, Olive Pei Ee and Qian, Suyun and Fan, Lijia and Konoike, Yoshihiko and Lee, Jan Hau and Asi, Pediat Acute Critical Care Med (2021) Early coagulopathy in pediatric traumatic brain injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study. Neurosurgery, 89 (2). pp. 283-290. ISSN 0148-396X, DOI https://doi.org/10.1093/neuros/nyab157 <https://doi.org/10.1093/neuros/nyab157>. 10.1093/neuros/nyab157 |
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R Medicine RJ Pediatrics Chong, Shu-Ling Ong, Gene Yong-Kwang Zheng, Charles Qishi Dang, Hongxing Ming, Meixiu Mahmood, Maznisah Chan, Lawrence Chi Ngong Chuah, Soo Lin Lee, Olive Pei Ee Qian, Suyun Fan, Lijia Konoike, Yoshihiko Lee, Jan Hau Asi, Pediat Acute Critical Care Med Early coagulopathy in pediatric traumatic brain injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study |
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Although early coagulopathy increases mortality in adults with traumatic brain injury (TBI), less is known about pediatric TBI. OBJECTIVE: To describe the prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet levels of children with moderate to severe TBI to identify predictors of early coagulopathy and study the association with clinical outcomes. METHODS: Using the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) TBI retrospective cohort, we identified patients <16 yr old with a Glasgow Coma Scale (GCS) <= 13. We compared PT, APTT, platelets, and outcomes between children with isolated TBI and multiple trauma with TBI. We performed logistic regressions to identify predictors of early coagulopathy and study the association with mortality and poor functional outcomes. RESULTS: Among 370 children analyzed, 53/370 (14.3%) died and 127/370 (34.3%) had poor functional outcomes. PT was commonly deranged in both isolated TBI (53/173, 30.6%) and multiple trauma (101/197, 51.3%). Predictors for early coagulopathy were young age (adjusted odds ratio aOR] 0.94, 95% CI 0.88-0.99, P = .023), GCS < 8 (aOR 1.96, 95% CI 1.26-3.06, P = .003), and presence of multiple trauma (aOR 2.21, 95% confidence interval CI] 1.37-3.60, P = .001). After adjusting for age, gender, GCS, multiple traumas, and presence of intracranial bleed, children with early coagulopathy were more likely to die (aOR 7.56, 95% CI 3.04-23.06, P < .001) and have poor functional outcomes (aOR 2.16, 95% CI 1.26-3.76, P = .006). CONCLUSION: Early coagulopathy is common and independently associated with death and poor functional outcomes among children with TBI. |
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Article |
author |
Chong, Shu-Ling Ong, Gene Yong-Kwang Zheng, Charles Qishi Dang, Hongxing Ming, Meixiu Mahmood, Maznisah Chan, Lawrence Chi Ngong Chuah, Soo Lin Lee, Olive Pei Ee Qian, Suyun Fan, Lijia Konoike, Yoshihiko Lee, Jan Hau Asi, Pediat Acute Critical Care Med |
author_facet |
Chong, Shu-Ling Ong, Gene Yong-Kwang Zheng, Charles Qishi Dang, Hongxing Ming, Meixiu Mahmood, Maznisah Chan, Lawrence Chi Ngong Chuah, Soo Lin Lee, Olive Pei Ee Qian, Suyun Fan, Lijia Konoike, Yoshihiko Lee, Jan Hau Asi, Pediat Acute Critical Care Med |
author_sort |
Chong, Shu-Ling |
title |
Early coagulopathy in pediatric traumatic brain injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study |
title_short |
Early coagulopathy in pediatric traumatic brain injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study |
title_full |
Early coagulopathy in pediatric traumatic brain injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study |
title_fullStr |
Early coagulopathy in pediatric traumatic brain injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study |
title_full_unstemmed |
Early coagulopathy in pediatric traumatic brain injury: A Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study |
title_sort |
early coagulopathy in pediatric traumatic brain injury: a pediatric acute and critical care medicine asian network (paccman) retrospective study |
publisher |
Oxford Univ Press Inc |
publishDate |
2021 |
url |
http://eprints.um.edu.my/34499/ |
_version_ |
1735570306320302080 |
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13.209306 |