Plasma D-dimer safely reduces unnecessary CT scans obtained in the evaluation of pediatric head trauma

Langness, Simone; Ward, E F; Halbach, Jonathan; Lizardo, Radhames E.; Davenport, Katherine P.; Bickler, Stephen W.; Kling, Karen; Thangarajah, Hari; Grabowski, Julia; Fairbanks, Timothy

doi:10.1016/j.jpedsurg.2017.08.017

Cited by 11 publications

(9 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…vWF measured within the first 48 h of admission was higher in traumatic hemorrhage compared with traumatic vascular injury, 54 whereas D-dimer measured within 6 h could not differentiate between patients with isolated skull fracture and mild intracranial injury on CT. 31 Although raised in mild head injury compared with controls, copeptin was not significantly different on groupwise comparison between patients with petechial hemorrhages, tSAH, SDH, and EDH. 14…”

Section: Miscellaneousmentioning

confidence: 74%

Blood Biomarkers and Structural Imaging Correlations Post-Traumatic Brain Injury: A Systematic Review

et al. 2021

View full text Add to dashboard Cite

BACKGROUND:Blood biomarkers are of increasing importance in the diagnosis and assessment of traumatic brain injury (TBI). However, the relationship between them and lesions seen on imaging remains unclear.OBJECTIVE:To perform a systematic review of the relationship between blood biomarkers and intracranial lesion types, intracranial lesion injury patterns, volume/number of intracranial lesions, and imaging classification systems.METHODS:We searched Medical Literature Analysis and Retrieval System Online, Excerpta Medica dataBASE, and Cumulative Index to Nursing and Allied Health Literature from inception to May 2021, and the references of included studies were also screened. Heterogeneity in study design, biomarker types, imaging modalities, and analyses inhibited quantitative analysis, with a qualitative synthesis presented.RESULTS:Fifty-nine papers were included assessing one or more biomarker to imaging comparisons per paper: 30 assessed imaging classifications or injury patterns, 28 assessed lesion type, and 11 assessed lesion volume or number. Biomarker concentrations were associated with the burden of brain injury, as assessed by increasing intracranial lesion volume, increasing numbers of traumatic intracranial lesions, and positive correlations with imaging classification scores. There were inconsistent findings associating different biomarkers with specific imaging phenotypes including diffuse axonal injury, cerebral edema, and intracranial hemorrhage.CONCLUSION:Blood-based biomarker concentrations after TBI are consistently demonstrated to correlate burden of intracranial disease. The relation with specific injury types is unclear suggesting a lack of diagnostic specificity and/or is the result of the complex and heterogeneous nature of TBI.

show abstract

Section: Miscellaneousmentioning

confidence: 74%

Blood Biomarkers and Structural Imaging Correlations Post-Traumatic Brain Injury: A Systematic Review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In addition, in most previous studies, the methods used to determine the correlation between D-dimer levels and TBI were relatively simple. For example, Simone et al found that the D-dimer level can be used as an evaluation method to reduce the use of unnecessary CT examinations in children with TBI through ROC model analysis ( Langness et al, 2018 ), and Xu et al (2020) found that the ratio of D-dimer/Fib can predict the incidence of progressive hemorrhagic injury after TBI through logistic regression and the ROC model. In this study, various statistical methods and models were used to determine the relationship between D-dimer levels and patient mortality at different time points.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, D-dimer levels were found to predict a poor neurological prognosis 6 months after discharge in patients with isolated TBI ( Fujiwara et al, 2022 ). Additionally, measurement of the D-dimer level can reduce unnecessary CT scans for head trauma assessment in children with TBI ( Berger et al, 2015 ; Langness et al, 2018 ). Understanding the prognostic factors aids in TBI severity assessment and treatment planning.…”

Section: Introductionmentioning

confidence: 99%

Plasma D-dimer levels are a biomarker for in-hospital complications and long-term mortality in patients with traumatic brain injury

Chen,

Wang,

Liu

et al. 2023

Front. Mol. Neurosci.

View full text Add to dashboard Cite

IntroductionTraumatic brain injury (TBI) is a major health concern worldwide. D-dimer levels, commonly used in the diagnosis and treatment of neurological diseases, may be associated with adverse events in patients with TBI. However, the relationship between D-dimer levels, TBI-related in-hospital complications, and long-term mortality in patients with TBI has not been investigated. Here, examined whether elevated D-dimer levels facilitate the prediction of in-hospital complications and mortality in patients with TBI.MethodsOverall, 1,338 patients with TBI admitted to our institute between January 2016 and June 2022 were retrospectively examined. D-dimer levels were assessed within 24 h of admission, and propensity score matching was used to adjust for baseline characteristics.ResultsAmong the in-hospital complications, high D-dimer levels were associated with electrolyte metabolism disorders, pulmonary infections, and intensive care unit admission (p < 0.05). Compared with patients with low (0.00–1.54 mg/L) D-dimer levels, the odds of long-term mortality were significantly higher in all other patients, including those with D-dimer levels between 1.55 mg/L and 6.35 mg/L (adjusted hazard ratio [aHR] 1.655, 95% CI 0.9632.843), 6.36 mg/L and 19.99 mg/L (aHR 2.38, 95% CI 1.416–4.000), and >20 mg/L (aHR 3.635, 95% CI 2.195–6.018; p < 0.001). D-dimer levels were positively correlated with the risk of death when the D-dimer level reached 6.82 mg/L.ConclusionOverall, elevated D-dimer levels at admission were associated with adverse outcomes and may predict poor prognosis in patients with TBI. Our findings will aid in the acute diagnosis, classification, and management of TBI.

show abstract

“…UCH-L1, D-dimer, Myelin Basic Protein (MBP), Neuron-Specific Enolase (NSE), Glial Fibrillary Acid Protein (GFAP), interleukin-6 and interleukin-8 have also been investigated to some extent in this regard. However, further evaluations are required before practicing their application (23,24,28). Such biomarkers have been investigated solely, and it may be logical to investigate them in combination in this regard.…”

Section: Blood-based Decision Making: Neuro-biomarkersmentioning

confidence: 99%

Reducing Unnecessary CT Scanning in Head Trauma of Pediatric Patients: A Narrative Review

et al. 2018

View full text Add to dashboard Cite

The current review article considered the latest published papers on reducing unnecessary head Computed Tomography (CT) scans in pediatric patients, to pave the way for further surveys. Evidence Acquisition: The papers were selected through Google Scholar and PubMed. We searched "reducing unnecessary head CT scan in pediatric patients" with related keywords compatible with MeSH system in accordance with the search strategy. Original articles and systematic reviews published after 2010 were included. Other types of manuscripts such as a letter to editor, editorial reviews, case series, etc. were excluded. The title and abstract of the eligible articles were assessed in terms of relevance to our topic. The full text of final selected papers were studied by the investigators. Furthermore, a critical appraisal was performed in an expert panel to summarize it and make it applicable. Results: The extracted manuscripts have addressed this issue by various strategies. The findings could be categorized as follows: observation period, focused history taking, protocol and guideline development, implementation of validated clinical prediction rules, and blood-based decision making by assessing neuro-biomarker levels. Conclusions: Most of the reviewed articles were focused on clinical findings to discover the minimum or low risk category of the pediatric patients with blunt head trauma. Other articles attempted on facilitating the use of available clinical prediction rules in this regard. Also, the measurement of serum biomarker levels has been considered; however, their widely application in practice is not well supported by evidence yet.

show abstract

Plasma D-dimer safely reduces unnecessary CT scans obtained in the evaluation of pediatric head trauma

Cited by 11 publications

References 45 publications

Blood Biomarkers and Structural Imaging Correlations Post-Traumatic Brain Injury: A Systematic Review

Blood Biomarkers and Structural Imaging Correlations Post-Traumatic Brain Injury: A Systematic Review

Plasma D-dimer levels are a biomarker for in-hospital complications and long-term mortality in patients with traumatic brain injury

Reducing Unnecessary CT Scanning in Head Trauma of Pediatric Patients: A Narrative Review

Contact Info

Product

Resources

About