The influence of hemocoagulative disorders on the outcome of children withhead injury

Background: Although disseminated intravascular coagulation (DIC) and other hemocoagulative abnormalities are severe complications of head injury, the ir effect on clinical outcome remains unclear, particularly among children. Objectives: To evaluate the frequency of hemocoagulative abnormalities and their influence on outcome among children with head injury. Study Design: We conducted a prospective observational study among 60 children with head injury, immediately evaluating severity of head injury (Glasgow Coma Scale, GCS); cerebral axial tomography; prothrombin time; activated partial throm boplastin time (aPTT); fibrinogen level; concentration of fibrin-fibrinogen degradation products (FDP), and platelet count. Two months after injury, w e applied the Glasgow Outcome Score (GOS). Associations with GOS were evalu ated using univariate and multivariate logistic models. Results: Among chil dren with severe head injury, 22.2% (6/27) developed DIC, all of whom died and had shown severe brain edema. Among those with severe head injury yet w ithout DIC, the mortality was only 14.2%. A low GOS was significantly and i ndependently associated with a low GCS, multiple trauma, delayed aPTT, low fibrinogen level, elevated FDP and low platelet count. Brain edema was also associated with a low GOS, though not significantly. Conclusions: In addit ion to GCS, type of trauma, type of brain lesion and certain coagulation ab normalities are predictors of GOS. Copyright (C) 2001 S. Karger AG, Basel.