Abstract
Background: Conflicting data exist regarding the association of traumatic brain injury (TBI) with coagulopathy as measured by conventional coagulation testing (CCT). Objective: This study is intended to determine the prevalence of coagulopathy in TBI patients by CCT and rapid thrombelastography (r-TEG) and to determine the relationship between these laboratory tests and mortality. Methods: Over an 18-month period, the admission r-TEG values (ACT, R-value, k-time, alpha, mA, and LY30) and CCTs (aPTT, INR, platelet count, and fibrinogen) were recorded on the highest-level trauma activations admitted directly from the injury scene. Patients were then categorized as non-TBI (Head AIS 0-2) or isolated TBI (Head AIS >2 and all other AIS scores ≤ 2), and all other patients were excluded. A patient has determined to have a coagulopathy if one or more of the following was present: aPTT>35 sec, INR>1.5, platelet count 128, R>1.1, k>2.5, alpha 3%. Results: 1847 non-TBI patients and 77 isolated-TBI were identified. No significant difference was detected between the groups by CCT, but the isolated-TBI group was found to have more patients with mA<55 by r-TEG (p=0.034). Multiple logistic regression revealed mA<55 (OR 3.68; p=0.015) or alpha<56 (OR 22.23; p<0.001) were predictive of 24-hour mortality in all patients. However, in isolated TBI patients, the presence of either of these hypocoagulable variables was uniformly fatal. Conclusion: No difference in coagulopathy prevalence was observed between TBI and non-TBI patients by CCT, but a higher prevalence of coagulopathy by r-TEG values was found in isolated TBI patients and was predictive of mortality.
Highlights
Traumatic brain injury (TBI) is the leading cause of mortality in trauma patients and accounts for up to 60% of traumatic deaths [1,2]
A slightly prolonged International Normalized Ration (INR) was noted in the isolated traumatic brain injury (TBI) group (p=0.013), no significant differences were observed in admission rapid thrombelastography (r-TEG) values
A higher prevalence of coagulopathy by r-TEG alpha (p=0.001) and maximal amplitude (mA) was observed in isolated TBI patients (p=0.039), no difference in the prevalence of coagulopathy by conventional coagulation testing (CCT) values was detected
Summary
Traumatic brain injury (TBI) is the leading cause of mortality in trauma patients and accounts for up to 60% of traumatic deaths [1,2]. In 2009, Talving et al published the only prospective data to date from a level I urban trauma center, demonstrating a 34-36% incidence of coagulopathy in TBI patients, as measured by International Normalized Ration (INR), activated partial thromboplastin time (aPTT), and platelet count. Independently associated risk factors for coagulopathy among isolated TBI patients included a GCS ≤ 8, an ISS ≥ 16, the presence of cerebral edema, subarachnoid hemorrhage, or a midline shift upon admission [4]. Conventional coagulation tests (CCTs) such as prothrombin time (PT), aPTT, INR, platelet counts, and fibrinogen levels have been used to diagnose and treat coagulopathy in TBI patients. Conflicting data exist regarding the association of traumatic brain injury (TBI) with coagulopathy as measured by conventional coagulation testing (CCT)
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