Traumatic Brain Injury Associated Coagulopathy

• Published in: Neurocritical care Vol. 22; no. 1; pp. 34 - 44
• Main Authors: de Oliveira Manoel, Airton Leonardo, Neto, Antonio Capone, Veigas, Precilla V., Rizoli, Sandro
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.02.2015; Springer Nature B.V
• Subjects: Adolescent; Adult; Age; Blood Coagulation Disorders - diagnosis; Blood Coagulation Disorders - epidemiology; Blood Coagulation Disorders - mortality; Blood platelets; Brain Injuries - epidemiology; Brain Injuries - mortality; Brain research; Comorbidity; Critical Care Medicine; Female; Head injuries; Hemoglobin; Humans; Intensive; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Missing data; Mortality; Neurology; Original Article; Patients; Plasma; Risk Factors; Severity of Illness Index; Trauma; Traumatic brain injury; Young Adult; Canada; Abbreviated injury scale score; Traumatic brain injury; Trauma-coagulopathy; DIC
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-014-0026-4

Background The presence of coagulopathy is common after severe trauma. The aim of this study was to identify whether isolated severe traumatic brain injury (TBI) is an independent risk factor for coagulopathy. Methods Prospective observational cohort of adult patients admitted to a Level I Trauma Center within 6 h of injury. Patients were categorized according to the abbreviated injury scale (AIS): Group 1-isolated severe TBI (AIS head ≥ 3 + AIS non-head < 3); Group 2-severe multisystem trauma associated with severe TBI (AIS head ≥ 3 + AIS non-head ≥ 3); Group 3-severe multisystem trauma without TBI (AIS head < 3 + AIS non-head ≥ 3). Primary outcome was the development of coagulopathy. Secondary outcome was in-hospital mortality. Results Three hundred and forty five patients were included (Group 1 = 48 patients, Group 2 = 137, and Group 3 = 160). Group 1 patients had the lowest incidence of coagulopathy and disseminated intravascular coagulopathy, and in general presented with better coagulation profile measured by either classic coagulation tests, thromboelastography or clotting factors. Isolated severe TBI was not an independent risk factor for the development of coagulopathy (OR 1.06; 0.35–3.22 CI, p  = 0.92), however, isolated severe TBI patients who developed coagulopathy had higher mortality rates than isolated severe TBI patients without coagulopathy (66 vs. 16.6 %, p  < 0.05). The presence of coagulopathy (OR 5.61; 2.65–11.86 CI, p  < 0.0001) and isolated severe TBI (OR 11.51; 3.9–34.2 CI, p  < 0.0001) were independent risk factors for in-hospital mortality. Conclusion Isolated severe TBI is not an independent risk factor for the development of coagulopathy. However, severe TBI patients who develop coagulopathy have extremely high mortality rates.