Relationship Between Acute Coagulopathy And Severity And Prognosis In Children With Traumatic Brain Injury

Objective:The changes of blood coagulation indexes in 389 children with simple traumatic brain injury were reviewed,and the relationship between the changes of blood coagulation function and disease severity and short-term prognosis in children with acute traumatic brain injury was analyzed,to provide objective clinical basis for the diagnosis and prognosis of traumatic brain injury.Methods:A retrospective analysis of the clinical data of children with traumatic brain injury treated in our neurosurgery department from March 2020 to March 2021.The inclusion criteria were as follows: 1)with a clear history of head trauma;2)age < 18 years old;3)no serious trauma to other system;4)first hospital admission after injury;5)complete clinical data.The exclusion criteria were 1)known coagulation disorders,such as hemophilia;2)recent anticoagulation therapy with anticoagulant drugs;3)other serious diseases,such as malignant tumors;4)combined with serious injuries at other system;5)have blood system diseases.A total of 389 children with traumatic brain injury were enrolled in the study,and all children had femoral venous blood specimens retained within 2 hours after admission for routine blood and coagulation tests.The patients were divided into three groups according to the GCS score at admission: light traumatic brain injury with a GCS score of13-15,medium with 12-9,and heavy with ≤8(Appendix).Basic information such as age at admission,gender,time from injury to admission,first post-injury CT presentation,treatment modality,coagulation indexes(including PT,APTT,TT,FIB,INR and PLT),FDP and D-dimer were collected for univariate multivariate analysis in the three groups of patients.6-month follow-up of discharged children,and the prognosis was evaluated by GOS score.The prognosis and blood coagulation of children with different severity of traumatic brain injury were statistically analyzed.GOS score > 3 was defined as a good prognosis.Results:A total of 389 children with acute traumatic brain injury in our hospital from March2020 to March 2021 met the inclusion criteria,including 266 males(68.38%)and 123females(31.62%).The time from injury to hospitalization was(6 ±5)h.The patients were divided into three groups based on their GCS score on admission: mild group(n = 291)(74.81%),medium group(n = 70)(17.99%),and severe group(n = 28)(7.20%).60 cases(15.42%)had normal CT results for the first time after injury,and 329 cases(84.58%)had abnormal CT results for the first time after injury.After admission,surgical treatment was performed in 32 cases(8.23%)and conservative treatment in 357 cases(91.77%).In the analysis of general clinical data of children with acute traumatic brain injury of different severity,age,the first CT findings after injury,and treatment methods in groups was statistically significant(P<0.05),the time after the injury and sex in groups was no statistical significance(P>0.05).Comparing the coagulation indexes of children with different degrees of acute traumatic brain injury,PT,INR,FIB,APTT,D-dimer,FDP and PLT in groups was statistically significant(P < 0.05).TT in groups was no statistical significance(P>0.05).Patients with mild traumatic brain injury were used as the control group,Multinomial Logistic Regression showed that age,PT,FIB and FDP were the risk factors of moderate traumatic brain injury,while PT and FDP were the risk factors of severe traumatic brain injury.The patients were followed up for 6 months.According to the GOS score,there were344 cases of good recovery(88.43%),28 cases of mild disability(7.20%),9 cases of severe disability(2.31%),1 case of vegetative survival(0.26%)and 7 cases of death(1.8%).The GOS score > 3 was defined as a good prognosis,a good prognosis of 372cases(95.63%)and a poor prognosis of 17 cases(4.37%).In the analysis of the influence of the severity of the disease on the prognosis of children with acute traumatic brain injury,there was a significant negative correlation between the severity of the injury and the GOS score(r=-0.666,P<0.05).By comparing the coagulation indexes of children with different prognosis,it was found that INR,PT,FIB,TT,D-d,FDP and PLT in groups was significant differences(P < 0.05),APTT in groups was no significant differences(P > 0.05).Conclusions:The change of blood coagulation after acute traumatic brain injury in children is related to the severity of the disease.The abnormality of blood coagulation index is helpful to evaluate the severity of traumatic brain injury in children.Monitoring the blood coagulation function has clinical guiding significance for assess injuries and may provide objective clinical evidence for evaluate the prognosis of traumatic brain injury.