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Aida Bounama, Brian J. Forbes, Cindy W. Christian, Jiayan Huang, Gui-shuang Ying, Kathleen E. Romero, Jules P. Antigua, Gil Binenbaum; Coagulopathy and Retinal Hemorrhage in Pediatric Head Trauma. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6765.
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To determine the association between coagulopathy and the presence of retinal hemorrhage (RH) in the setting of pediatric head trauma.
Single-center retrospective cohort study of children under age 3 years with inflicted or accidental head trauma, blood tests for coagulopathy, and dilated fundus exam by a pediatric ophthalmologist. Abuse was defined using criteria that excluded eye findings. RH was recorded as present or absent. Coagulation tests were classified as basic (PT, INR, PTT, platelets) or extensive (Factors II (prothrombin), V, VII, VIII, IX, X, XI, XII; fibrinogen; fibrin degradation products; D-dimer; ATIII; Proteins C, S; Factor V Leiden; homocysteine; vitamin K; vWF antigen, activity, multimers; bleeding time; platelet aggregation). Earliest available tests from admission and age-adjusted cut-offs were used, including PT>14, INR>1.2, PTT>36, platelets<100,000.
151 children (88 inflicted head injury, 51 accidental, 12 indeterminate) were studied; median age, 3.75 months (range 0.2 to 35.7). RH was present in 52 (34%) children (43 (49%) of inflicted injuries, 5 (11%) of accidental injuries). 133 (88%) had ICH. All children had basic coagulation testing; 84 had one or more extensive tests as well, of which 40 (48%) had RH. 58 (38%) had coagulopathy on basic testing; 73 (48%) had coagulopathy on basic or extensive testing. There was no significant relationship between the presence of RH and coagulopathy defined using basic tests alone or basic plus extensive tests, whether considered overall or in the abusive and accidental subgroups (all p>0.50, Fisher exact).
The presence of coagulopathy was not associated with increased likelihood of RH in children suffering abusive or accidental head trauma. While the higher prevalence of RH in children receiving extensive testing suggests confounding by indication, the resulting bias would be away from the null and therefore would not change the study findings. Further investigation is required to determine if a significant relationship exists when the severities of coagulopathy, RH, head trauma, and brain injury are considered.
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