Post-trauma coagulation and fibrinolysis in children suffering from severecerebro-cranial trauma

The present study was designed to evaluate the post-trauma haemostatic chan ges in 27 children with severe cranio-cerebral trauma defined by a modified Glasgow Coma Score (GCS) < 10. Blood samples for coagulation studies (fibr inogen, von Willebrand factor (vWf), factor VIII:C, antithrombin, protein C , plasminogen, tissue-type plasminogen activator (t-PA), plasminogen activa tor inhibitor-1 (PAI), D-dimer) were obtained within two hours of admission , 24 h later, and on days 3-5, 7-9, 21 and 35. Data of this study indicate that alterations of coagulation in paediatric patients are similar to those in adults: On hospitalisation, activated haemostasis was found with decrea sed fibrinogen, antithrombin and protein C along with enhanced t-PA and PAI . Twenty-four hours later, hypercoagulability with significantly increased VWF and fibrinogen started, with a peak level within the second week. Withi n 24 h of admission, 17 children developed disseminated intravascular coagu lation (DIC) with a clear-cut decrease of antithrombin and fibrinogen toget her with platelet consumption and enhanced D-dimer. The outcome of children with DIC was significantly poorer than in those without DIG. Complete reco very was seen in five patients; sequelae no handicap and moderate disabilit y were each found in six patients. Severe disability was diagnosed in two c hildren, and fulminant DIC with lethal outcome occurred in eight patients. The GCS (P < 0.01) and the occurrence of DIC (P < 0.005) showed the stronge st association with the patients' clinical outcome. Conclusion Our data underline the significance of post-trauma disturbances of the haemostatic system for the clinical course and outcome in children w ith severe craniocerebral injuries.