Plasma D-dimer safely reduces unnecessary CT scans obtained in the evaluation of pediatric head trauma.

Abstract

PURPOSE:

Serum D-dimer has been proposed as a biomarker to aid in the diagnosis of pediatric traumatic brain injury (TBI). We investigated the accuracy of D-dimer in predicting the absence of TBI and evaluated the degree by which D-dimer could limit unnecessary computed tomography scans of the head (CTH).

METHODS:

Retrospective review of patients with suspected TBI from 2011 to 2013 who underwent evaluation with CTH and quantitative D-dimer. D-dimer levels were compared among patients with clinically-important TBI (ciTBI), TBI, isolated skull fracture and no injury.

RESULTS:

Of the 663 patients evaluated for suspected TBI, ciTBI was identified in 116 (17.5%), TBI in 77 (11.6%), skull fracture in 61 (9.2%) and no head injury in 409 (61.7%). Patients with no head injury had significantly lower D-dimer values (1531±1791pg/μL) compared to those with skull fracture, TBI and ciTBI (2504±1769, 2870±1633 and 4059±1287pg/μL, respectively, p<0.005). Using a D-dimer value <750pg/μL as a negative screen, no ciTBIs would be missed and 209 CTHs avoided (39.7% of total).

CONCLUSION:

Low plasma D-dimer predicts the absence of ciTBI for pediatric patient with suspected TBI. Incorporating D-dimer into current diagnostic algorithms may significantly limit the number of unnecessary CTHs performed in this population.

TYPE OF STUDY:

Study of diagnostic test.

LEVEL OF EVIDENCE:

I.

• Authors: Simone Langness, Erin Ward, Jonathan Halbach, Radhames Lizardo, Katherine Davenport, Stephen Bickler, Karen Kling, Hari Thangarajah, Julia Grabowski, Timothy Fairbanks
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 53 Issue 4 Pg. 752-757 (Apr 2018) ISSN: 1531-5037 [Electronic] United States
• PMID: 29555324 (Publication Type: Journal Article, Validation Study)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Fibrin Fibrinogen Degradation Products
• fibrin fragment D

Topics

• Adolescent
• Biomarkers (blood)
• Child
• Child, Preschool
• Craniocerebral Trauma (blood, diagnostic imaging)
• Female
• Fibrin Fibrinogen Degradation Products (metabolism)
• Humans
• Infant
• Infant, Newborn
• Male
• Retrospective Studies
• Skull Fractures (blood, diagnostic imaging)
• Tomography, X-Ray Computed
• Trauma Severity Indices