Comparative study of derangement of coagulation profile between adult and pediatric population in moderate to severe traumatic brain injury: A prospective study in a tertiary care trauma center

Abstract

Object:Coagulopathy is a common occurrence following traumatic brain injury (TBI). There are various studies showing incidence and risk factors of coagulopathy and their correlation with poor outcome in adult as well as paediatric age groups. Exact incidence, associated risk factors, treatment guideline for coagulopathy and its impact on outcome are still lacking. In our study we compared the adults and paediatric age groups TBI patients for incidence and risk factors of coagulopathy and its impact on outcome.Methods:Prospective study of 200 patients including 152 adult patients (age > 18 years) and 48 paediatric (Age < 18 years) patients of TBI admitted in intensive care unit of trauma centre of a tertiary care centre was performed from august 2015 to march 2016. Both population were further subdivided into moderate TBI and severe TBI as per Glasgow coma score (GCS). Patient with long bone injury, chest injury and abdominal injuries, coagulation disorder, liver disease, medical disease like diabetes mellitus and hypertension were excluded from study. Coagulation profile were compared in the both groups (Adult and paediatric) and correlated with the outcome. Chi- Square test, student t test and Odds ratios were used for statistical analysis.Results:Mean age among the adult and paediatric population were 37.89 ± 11.88 years and 11.41 ± 5.90, respectively. Among the patient with moderate TBI, coagulopathy was seen in 30% patients of adult TBI whereas it was 12.5% among the paediatric TBI (P = 0.185). Among the severe TBI group coagulopathy was observed in 68.03% and 37.5% of adult and paediatric age group respectively (P = 0.0016). There was significant correlation found between midline shift and coagulopathy in the paediatric age group (P = 0.022; OR - 4.58). E. There was significant association of coagulopathy and contusion on CT scan among the adult population (P = 0.007; OR - 3.487) found whereas no such correlation were observed in paediatric population.Conclusion:Coagulopathy was significantly higher among the adult patient with severe TBI as compare to paediatric patient with severe TBI. There was no statistically significant difference in mortality among patients of both the age groups with coagulopathy.

Coagulopathy and Its Associated Factors Among Bleeding Diathesis Patients Attending at University of Gondar Specialized Referral Hospital, Northwest Ethiopia.

“…The current study was in agreement with a study conducted by Tapia et al in American which reported a 65.6% prevalence of bleeding disorder (13). In contrast, the prevalence of this study was higher than a study conducted in Egypt (23%) (7), India (53%) (30), and America (47%) (14). The possible reasons for the discrepancies might be associated with differences in the study population, study period, geographical variability, detection method, and implementation of different strategies to minimize the burden of coagulopathy in the region where studies have been conducted.…”

“…Coagulopathy is mostly associated with chronic diseases (23,29,36,37), parasitic infection (38), and some viral agents (30). In this study cardiac disease, and other chronic diseases were signi cantly associated with coagulopathy.…”

A Selection of Trauma Scores Might Not Correlate with Coagulation Factor Activity following Multiple Injuries: A Retrospective Observational Study from a Level 1 Trauma Center

“…Coagulation disorders associated with traumatic brain injury (TBI) have been known for a long time, but what exactly triggers their development is still not fully understood [ 31 ]. Indeed, it has been shown that lower GCS values are related to coagulopathy in injured adults and children alike [ 32 ]. Yet, the GCS in our study was only a poor indicator of coagulation factor activity ( Table 5 ).…”

Relationship between admission coagulopathy and prognosis in children with traumatic brain injury: a retrospective study

“…Traumatic brain injury (TBI) is one of the leading causes of trauma-induced mortality and disability in children and adolescents [1]. Coagulation dysfunction is frequently observed following TBI, especially in patients with severe TBI [2][3][4]. Although there is a trend toward increased use of dynamic hemostatic assays such as thromboelastography (TEG), coagulopathy is still commonly diagnosed by routine coagulation laboratory tests, including the International normalized ratio (INR), activated partial thromboplastin time (APTT) and others, in developing countries.…”

“…In one comparative study that included pediatric and adult trauma patients, Strumwasser et al [9] reported that TBI-related coagulopathy increased in a stepwise fashion with age. Dwivedi et al [3] found that coagulopathy was present in 37.5 % of the pediatric TBI group and 68.03 % of the adult group, and there was a high mortality rate in the coagulopathy group in both the adult and pediatric populations (63.04 and 50 %, respectively). However, it is noteworthy that the population of the pediatric TBI group in their study was relatively small (n = 48) [3].…”