Hemophilia with Head Trauma Clinical Pathway — Emergency Department

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Goals and Metrics

Patient Education

Provider Resources

Related Pathway

Head Trauma, Acute, ED

Child with Hemophilia and Closed Head Injury

Goal

Children with factor level < 1% who are not on emicizumab are at highest risk
- Give factor correction or bypassing agent as soon as able
- Use home supply
- Hematology will order more factor for family

Guidance for Hematology Providers

Determine
- Factor level at the time of injury
- Mechanism of injury
- Presence of inhibitors
If on emicizumab (Hemlibra), treat like mild hemophilia
Trivial head trauma does not require factor correction or ED referral
Head Trauma Categorization

Factor level ≥ 1% or on emicizumab
and
mild head injury

Does not require factor correction or bypassing agent
Consider ED referral as indicated

Factor level ≥ 1% or on emicizumab
and
significant head injury

Factor level < 1%, not on emicizumab
and
mild or significant head injury

Immediate 100% factor correction or bypassing agent if family able, refer to CHOP ED

ED Triage

ED Team Assessment

History and Physical
Immediate correction
- Factor replacement if no active inhibitors
- Bypassing agent for active inhibitors
Review problem list for dosing
Use child’s home supply if available
Non-contrast head CT
Hematology consult

Discharge Criteria

Normal head CT
Normal exam
Asymptomatic
Ability of family to do follow-up care
Hemophilia team will order replacement factor
if child’s home supply was used

Admission Criteria

Abnormal head CT
Abnormal exam
Persistent symptoms
Significant head trauma
Admitted children should receive additional factor correction per Hematology

Posted: August 2005
Last Revised: January 2025, Revisions

Authors:
- R. Butler;
- L. Raffini, MD;
- C. Witmer, MD;
- C. Jacobstein, MD;
- J. Lavelle, MD

Evidence

CHOP Programs

Division of Hematology

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

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Emergency Department Clinical Pathway for Evaluation/Treatment of Children with Hemophilia and Closed Head Injury (CHI)

Evidence

CHOP Programs

Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Hemophilia and Closed Head Injury (CHI)