Trauma-induced coagulopathy in pediatric traumatic brain injury: incidence, risk factors, and outcomes in a retrospective cohort study

To delineate the incidence, independent determinants, and prognostic impact of trauma-induced coagulopathy (TIC) following pediatric moderate-to-severe traumatic brain injury (msTBI). Children with msTBI admitted to the Children’s Hospital of Soochow University during 2016–2024 were retrospectively enrolled. Logistic regression was first used to identify predictors of TIC. Kaplan–Meier (KM) curves were then constructed to visualize the influence of TIC on in-hospital and 28-day mortality. Univariable and multivariable models were employed to estimate the association between TIC and survival, with adjustment for demographics, clinical presentation, and imaging characteristics. Among 319 msTBI children, TIC is diagnosed in 173 (54.2%). Independent determinants comprise GCS ≤ 8 (OR 2.98; 95% CI 1.67–5.33), abnormal Shock Index Pediatric-Adjusted (SIPA) (OR 2.91; 95% CI 1.64–5.17), long-bone fracture (OR 2.6; 95% CI 1.18–5.74), and cerebral contusion (OR 1.51; 95% CI 1.28–1.92). Kaplan–Meier curves demonstrate persistently lower survival in the TIC group, with adjusted hazard ratios of 12.26 (95% CI 2.42–62.14, P = 0.002) for in-hospital mortality and 9.52 (95% CI 1.94–46.83, P = 0.005) for 28-day mortality. After adjustment, TIC is not associated with an increased likelihood of neurosurgical intervention (OR 1.29, P = 0.49). TIC is frequently encountered and carries a disproportionately high mortality in pediatric msTBI. A GCS ≤ 8, abnormal SIPA, long-bone fracture, or cerebral contusion independently flags high-risk patients; these variables are prioritized for early surveillance and targeted intervention.