Chiaretti A, Pezzotti P, Mestrovic J, Piastra M, Polidori G, Storti S, Velardi F, Di Rocco C
Pediatric Intensive Care Unit, Catholic University Medical School, I-00168 Rome, Italy.
Pediatr Neurosurg. 2001 Mar;34(3):131-7. doi: 10.1159/000056008.
Although disseminated intravascular coagulation (DIC) and other hemocoagulative abnormalities are severe complications of head injury, their effect on clinical outcome remains unclear, particularly among children.
To evaluate the frequency of hemocoagulative abnormalities and their influence on outcome among children with head injury.
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 thromboplastin time (aPTT); fibrinogen level; concentration of fibrin-fibrinogen degradation products (FDP), and platelet count. Two months after injury, we applied the Glasgow Outcome Score (GOS). Associations with GOS were evaluated using univariate and multivariate logistic models.
Among children 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 without DIC, the mortality was only 14.2%. A low GOS was significantly and independently 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.
In addition to GCS, type of trauma, type of brain lesion and certain coagulation abnormalities are predictors of GOS.
尽管弥散性血管内凝血（DIC）及其他血液凝固异常是颅脑损伤的严重并发症，但其对临床结局的影响仍不明确，尤其是在儿童中。
评估颅脑损伤患儿血液凝固异常的发生率及其对结局的影响。
我们对60例颅脑损伤患儿进行了一项前瞻性观察研究，立即评估颅脑损伤的严重程度（格拉斯哥昏迷量表，GCS）；脑轴位断层扫描；凝血酶原时间；活化部分凝血活酶时间（aPTT）；纤维蛋白原水平；纤维蛋白-纤维蛋白原降解产物（FDP）浓度及血小板计数。受伤2个月后，我们应用格拉斯哥预后评分（GOS）。使用单因素和多因素逻辑模型评估与GOS的相关性。
在重度颅脑损伤患儿中，22.2%（6/27）发生了DIC，所有这些患儿均死亡且均出现了严重脑水肿。在重度颅脑损伤但未发生DIC的患儿中，死亡率仅为14.2%。低GOS与低GCS、多发伤、aPTT延迟、纤维蛋白原水平低、FDP升高及血小板计数低显著且独立相关。脑水肿也与低GOS相关，但不显著。
除GCS外，创伤类型、脑损伤类型及某些凝血异常是GOS的预测因素。
