Early Coagulopathy Increases Mortality Risk in Children With TBI

Neurology research, conceptual image. Scientist preparing a multi well plate in front of brain scans.
Researchers sought to determine the prothrombin time, activated partial thromboplastin time, and platelet levels of children with TBI to identify predictors of early coagulopathy and clinical outcomes.

Early coagulopathy increases the risk of mortality and poor functional outcomes in both adults and children with traumatic brain injury (TBI), according to study results published in Neurosurgery.

This study was a retrospective review of the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) TBI cohort. Study researchers identified 370 children younger than 16 years of age who were admitted to a pediatric intensive care unit within 24 hours of a head injury with a Glasgow Coma Scale (GCS) of 13 or less.

The study researchers compared children with isolated TBI vs those with multiple trauma plus TBI regarding prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet levels. They also examined possible predictors of early coagulopathy and investigated the association of early coagulopathy with mortality and poor functional outcome.

Approximately 14.3% of the cohort died, and 34.3% experienced poor functional outcomes. A higher proportion of patients with multiple trauma and TBI had deranged PT compared with those with isolated TBI (51.3% vs 30.6%, respectively).

Independent predictors for early coagulopathy included young age (adjusted odds ratio [aOR], 0.94; 95% CI, 0.88-0.99; P =.023), GCS of less than 8 (aOR, 1.96; 95% CI, 1.26-3.06; P =.003), and the presence of multiple trauma (aOR, 2.21; 95% CI, 1.37-3.60; P =.001).

In an analysis adjusted for age, sex, GCS, multiple traumas, and presence of intracranial bleed, those who had early coagulopathy had a greater likelihood of dying (aOR, 7.56; 95% CI, 3.04-23.06; P <.001) and poor functional outcomes (aOR, 2.16; 95% CI, 1.26-3.76; P =.006).

Independent predictors of poor neurologic outcome included early coagulopathy (aOR, 2.16; 95% CI, 1.26-3.76; P =.006), child abuse as the mechanism of injury (aOR, 4.25; 95% CI, 1.37-13.36; P =.012), a GCS of less than 8 (aOR, 4.68; 95% CI, 2.76-8.12; P <.001), and hyperosmolar therapy (aOR, 2.57; 95% CI, 1.45-4.63; P =.001).

Limitations of this study were the lack of data on the long-term postintervention coagulation profile of patients as well as the heterogeneous nature of the group of patients with TBI plus multiple traumas.

The study researchers concluded that additional investigations “that study early correction of coagulopathy will be imperative to understand if modification of early coagulopathy will reduce mortality and improve functional outcomes in critically ill children with TBI.”


Chong SL, Ong GY, Zheng CQ, et al. Early coagulopathy in pediatric traumatic brain injury: a Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) retrospective study. Neurosurgery. Published online April 29, 2021. doi:10.1093/neuros/nyab157