Low plasma D-dimer concentration predicts the absence of traumatic brain injury in children.
Low plasma D-dimer concentration predicts the absence of traumatic brain injury in children.
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低血浆 D-二聚体浓度预示儿童不会出现创伤性脑损伤。
DOI：
10.1097/ta.0b013e3181d7a6f2
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Peterson,BradM
中科院分区：
文献类型：
--
作者：
Swanson,CraigA;Burns,JaneC;Peterson,BradM
背景：头部计算机断层扫描（CT）具有显著的风险，尤其是在儿童中。为了减少这一负担，我们试图开发一个生物标志物面板，预测没有创伤性脑损伤（TBI）的头部CT.Methods：我们进行了一项前瞻性队列观察性研究，然后在一个区域的儿科创伤中心的回顾性队列验证。前瞻性队列包括2007年9月至2008年3月期间在急诊科接受TBI评估的57名连续儿童。在初始评价时，采集血液以测量电解质、凝血标志物、全血细胞计数和血浆s100β、d-二聚体和基质金属蛋白酶-9水平。我们进行了常规的统计分析，以确定哪种预测TBI的头部CT。独立的回顾性队列包括57例连续评估相同indication.Results：所有患者一般符合常见的临床标准（如CHALICE标准4）头部CT创伤后。经单因素分析，血浆D-二聚体水平与头部CT显示的TBI相关（p< 0.001）。其他标志物包括凝血酶原时间、部分凝血活酶时间和s100β均未检测到。在多变量分析中，d-二聚体也具有最强的相关性（p= 0.02）。这种关联独立于基线奶牛昏迷量表，并且比基线奶牛昏迷量表更强（p= 0.08）。D-二聚体水平的临界值为500 pg/μl时，头部CT显示脑损伤的阴性预测值为94%（p< 0.001）。在独立的回顾性coherent.Conclusions：在儿童谁符合创伤后头部CT扫描的临床标准，低血浆D-二聚体水平的歧视能力得到证实，表明没有显着的脑损伤。
Background:Head Computerized Tomography (CT) has significant risks, especially in children. To reduce this burden, we sought to develop a biomarker panel that predicts the absence of traumatic brain injury (TBI) on head CT.Methods:We conducted a prospective cohort observational study followed by validation in a retrospective cohort at a regional pediatric trauma center. The prospective cohort included 57 consecutive children evaluated for TBI in the emergency department between September 2007 and March 2008. At the time of initial evaluation, blood was obtained to measure electrolytes, coagulation markers, complete blood count, and plasma levels of s100β, d-dimer, and matrix metalloproteinase-9. We conducted routine statistical analysis to determine which predicted TBI on head CT. The independent retrospective cohort included 57 consecutive patients evaluated for the same indication.Results:All patients generally met common clinical criteria (such as the CHALICE criteria 4) for head CT after trauma. Plasma levels of d-dimer were associated with TBI on head CT by univariate analysis (p< 0.001). Other markers including prothrombin time, partial thromboplastin time, and s100β were not. d-Dimer also had the strongest association in multivariate analysis (p= 0.02). This association was independent of and stronger than the baseline Glascow Coma Scale (p= 0.08). A d-dimer level cut-off of 500 pg/μl had 94% negative predictive value (p< 0.001) for brain injury on head CT. The discriminatory capacity of this d-dimer level was confirmed in the independent retrospective cohort.Conclusions:In children who meet clinical criteria for a head CT scan after trauma, low plasma d-dimer suggests the absence of significant brain injury.
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