Head Trauma and Intracranial Hemorrhage in Children With Idiopathic Thrombocytopenic Purpura

Background The current guidelines for management of idiopathic thrombocytopenic purpura (ITP) does not address head trauma and the current emergency pediatric head trauma management guidelines do not address children with ITP. The characteristics of patients who develop intracranial hemorrhage (ICH) as a result of head trauma or the management of head trauma in patients with ITP are not clear. Objectives Review the literature to identify and describe the characteristics and outcomes of intracranial haemorrhage as a result of head trauma in children with ITP. Methods We reviewed literature using Medline, Embase, and PUBMED databases from inception until December 2013. Articles were included if they described patients with head trauma and intracranial bleeding in children with ITP. Nine relevant articles met inclusion criteria and were included. Three case reports, 3 institution survey studies, and 5 retrospective chart reviews. Results There were 114 cases of ICH reported in children with ITP, and 26% (n = 30) were identified to have ICH due to head trauma. Of the 30 children with ITP who had an ICH in the context of head injury, 23% (7 patients) died as a result of ICH and 13% (4 patients) suffered significant neurological sequelae. Twenty-seven percent were 3 years or younger when the age was reported Conclusions Intracranial haemorrhage after head trauma in children with ITP leads to significant morbidity and mortality. As such, more thorough investigations, including radiological imaging and aggressive treatment, are recommended for children with ITP presenting with head injuries.