Glasgow Coma Scale as a predictor for hemocoagulative disorders after blunt pediatric traumatic brain injury
Pediatric Critical Care, 07/11/2012
Peiniger S et al. – Glasgow Coma Scale ≤8 at scene in children with isolated traumatic brain injury is associated with increased risk for coagulopathy and mortality. These results may guide laboratory testing, management, and blood bank resources in acute pediatric trauma care.Methods
- Two hundred datasets of children (age <14yrs) with blunt isolated traumatic brain injury were analyzed: children were subdivided into two groups according to Glasgow Coma Scale at the scene (Glasgow Coma Scale ≤8 vs. Glasgow Coma Scale >8) and reviewed for coagulation abnormalities upon emergency room admission and outcome.
- Fifty–one percent (n=102 of 200) of children had Glasgow Coma Scale >8 and 49% (n=98 of 200) had Glasgow Coma Scale ≤8 at the scene.
- The incidence of coagulopathy at admission was higher in children with Glasgow Coma Scale ≤8 compared to children with Glasgow Coma Scale >8: 44% (n=31 of 71) vs. 14% (n=11 of 79) (p<.001).
- Multivariate logistic regression revealed that Glasgow Coma Scale ≤8 at scene was associated with coagulopathy at admission (odds ratio 3.378, p=.009) and stepwise regression identified Glasgow Coma Scale ≤8 as an independent risk factor for coagulopathy.
- Mortality in children with Glasgow Coma Scale ≤8 at scene was substantially higher with the presence of coagulation abnormalities at admission compared to children in which coagulopathy was absent (51.6%, n=16 of 31 vs. 5% n=2 of 40).