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

Simone Langness, Erin Ward, Jonathan Halbach, Radhames Lizardo, Katherine Davenport, Stephen Bickler, Karen Kling, Hari Thangarajah, Julia Grabowski, Timothy Fairbanks*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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 ± 1791 pg/μL) compared to those with skull fracture, TBI and ciTBI (2504 ± 1769, 2870 ± 1633 and 4059 ± 1287 pg/μL, respectively, p < 0.005). Using a D-dimer value < 750 pg/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.

Original languageEnglish (US)
Pages (from-to)752-757
Number of pages6
JournalJournal of pediatric surgery
Volume53
Issue number4
DOIs
StatePublished - Apr 2018

Keywords

  • Clinically-important traumatic brain injury
  • D-dimer
  • Head CT scan
  • Negative predictive value
  • Pediatric head trauma
  • Skull fracture
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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