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Coagulation tests in inflicted head injury

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    When child abuse is suspected the finding of abnormal coagulation test results may be seized upon by the defence as evidence of pre-existing bleeding disorder. Now data from Denver, Colorado (Kent P Hymel and colleagues, Pediatrics1997;99:371-5) suggest that inflicted head trauma may cause such abnormalities.  The records of 265 children with inflicted head injury were reviewed and adequate data were available from 147 of whom 101 had computed tomography and/or magnetic resonance imaging evidence of injury to brain substance (IBS). A mildly prolonged prothrombin time was found in 54% of patients with and 20% without IBS. Median prothrombin time (normal 11.8 +/-1.0) was 13.1 with IBS and 12.0 without. Presumptive evidence of disseminated intravascular coagulation was found in 37% of IBS and 7% of non-IBS patients. Mortality in IBS children was 32% and of those who died 94% had prolonged prothrombin time and 63% evidence of disseminated intravascular coagulopathy.  Head injury in children may cause coagulation test abnormalities and the medicolegal significance of this finding needs to be acknowledged.

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