Podolsky-Gondim Guilherme Gozzoli, Furlanetti Luciano Lopes, Viana Dinark Conceição, Ballestero Matheus Fernando Manzolli, de Oliveira Ricardo Santos
Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, Brazil.
Department of Neurosurgery, University of Saarland, Homburg, Germany.
Childs Nerv Syst. 2018 Dec;34(12):2455-2461. doi: 10.1007/s00381-018-3989-1. Epub 2018 Oct 18.
Head injury is a significant economic, social, and medical problem in developing countries and remains one of the leading causes of pediatric morbidity and mortality. The association of traumatic brain injury and coagulopathy in children is linked with an increase in mortality and poor functional outcomes. However, its impact on long-term outcome has not been discussed in the literature so far.
The aim of this paper was to investigate the effect of coagulopathy diagnosed by routine laboratory tests on neurological outcome following traumatic brain injury in children.
A retrospective review was carried out using medical records of children with a traumatic brain injury admitted at a level I trauma center, between January 2013 and December 2016, submitted to any neurosurgical procedures. Statistical analysis was performed accordingly to identify factors predicting unfavorable or favorable outcomes at 1- and 6-month follow-ups. Data regarding age, gender, trauma mechanism, Glasgow Coma Scale at admission and at discharge, highest and lowest stable intracranial pressure, serum glucose and coagulation assessment, radiological findings, and length of stay were analyzed.
We identified 66 children with surgical head trauma. Mean age was 10.9 years (ranges from 3 months to 17 years), with male predominance (77.3%). Common mechanisms were road traffic accidents (66.7%), falls (19.7%), and blunt trauma (10.6%). Brain edema was detected in 68.2% of the patients, surgical fractures or intracranial bleeding in 75.8%. ICP monitoring was performed in 24.2% of the patients, and of these, 18.7% underwent consecutive decompressive craniectomy. Mean length of in-patient treatment was 16.3 ± 28.2 days. At 1- and 6-month follow-ups, favorable outcome was detected in 71.2 and 78.7% of the patients, respectively. The mortality rate was 12.1%. Routine coagulation assessments such as prothrombin time, fibrinogen levels, and thrombocyte count upon admission were potential prognostic variables identified.
The present study concluded that a trauma-related coagulopathy is an important predictor of unfavorable neurological outcome following TBI in pediatric patients. Initial GCS score, age, and neuroradiological findings, such as severe brain edema and different types of intracranial bleeding, correlated with GOS in the first 6 months following TBI. Sustained intracranial hypertension also predicted unfavorable outcome and death in this series.
在发展中国家，头部损伤是一个重大的经济、社会和医学问题，仍然是儿童发病和死亡的主要原因之一。儿童创伤性脑损伤与凝血病的关联与死亡率增加和功能预后不良有关。然而，其对长期预后的影响在目前的文献中尚未得到讨论。
本文旨在研究通过常规实验室检查诊断的凝血病对儿童创伤性脑损伤后神经功能预后的影响。
对2013年1月至2016年12月在一级创伤中心收治的、接受过任何神经外科手术的创伤性脑损伤患儿的病历进行回顾性研究。进行统计分析以确定在1个月和6个月随访时预测不良或良好预后的因素。分析了有关年龄、性别、创伤机制、入院时和出院时的格拉斯哥昏迷量表、最高和最低稳定颅内压、血糖和凝血评估、影像学检查结果以及住院时间的数据。
我们确定了66例接受头部手术创伤的患儿。平均年龄为10.9岁（范围从3个月至17岁），以男性为主（77.3%）。常见机制为道路交通事故（66.7%）、跌倒（19.7%）和钝器伤（10.6%）。68.2%的患者检测到脑水肿，75.8%的患者有手术骨折或颅内出血。24.2%的患者进行了颅内压监测，其中18.7%接受了连续减压颅骨切除术。平均住院治疗时间为16.3±28.2天。在1个月和6个月随访时，分别有71.2%和78.7%的患者预后良好。死亡率为12.1%。入院时的凝血酶原时间、纤维蛋白原水平和血小板计数等常规凝血评估是确定的潜在预后变量。
本研究得出结论，创伤相关凝血病是小儿创伤性脑损伤后神经功能不良预后的重要预测因素。最初的格拉斯哥昏迷量表评分、年龄以及神经影像学检查结果，如严重脑水肿和不同类型的颅内出血，与创伤性脑损伤后最初6个月的格拉斯哥预后评分相关。持续性颅内高压在本系列研究中也预示着不良预后和死亡。
