Disseminated intravascular coagulation (DIC) associated with head trauma. With special reference to the prognostic significance of FDP assay

Abstract

Coagulation study was performed on 40 patients who were admitted shortly after a blunt head trauma, and platelet count, prothrombin time, activated partial thromboplastin time, fibrin/fibrinogen degradation product concentration, and fibrinogen concentration were determined. Patients with any possible cause, other than a head injury, were excluded. Twenty seven cases (67.5% of all patients) showed at least one or more abnormal record in the coagulation tests, and 6 cases (15%) developed DIC according to the laboratory data. Three patients out of six DICs showed apparent clinical signs of coagulopathy. Seven patients out of the 40 cases examined expired, of which 5 cases belonged to the DIC group. In one autopsy case fibrin microthrombi were found by immunofluorescence staining in the renal glomeruli. Using the Glasgow Coma Scale on the patients when admitted, the relationship between clotting abnormalities and severity of the cerebral injury were analyzed. The results indicated that the DIC occurred in a significant number of patients with severe head trauma and that the fibrin degradation product (FDP) assay was the most useful test indicating the severity of cerebral injury of all coagulation tests. One of the patients in this series was found to have a highly elevated FDP concentration, and the patient later developed a delayed intracerebral hematoma.