Acquired coagulopathy of traumatic brain injury defined by routine laboratory tests

Which laboratory values matter?

Bellal Joseph, Hassan Aziz, Bardiya Zangbar, Narong Kulvatunyou, Viraj Pandit, Terence OKeeffe, Andrew Tang, Julie Wynne, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

BACKGROUND: Coagulopathy is a major determinant of disability and death in patients with traumatic intracranial hemorrhage. However, the correlation between coagulopathy defined by routine coagulation tests and clinical outcomes in traumatic brain injury (TBI) is not well defined. The aim of our study was to determine the effect of coagulopathy diagnosed by routine laboratory tests on outcomes in TBI patients. METHODS: We performed a retrospective cohort analysis of all isolated TBI patients exclusive of prehospital antiplatelet and anticoagulants with coagulation tests, namely, international normalized ratio (INR), platelet count, and partial thromboplastin time at admission. We defined coagulopathy by an INR of 1.5 or greater, partial thromboplastin time of 35 or greater, or platelet count of 100 × 103/μL or less. Outcome measures were progression on repeat head computed tomography (RHCT), need for neurosurgical intervention, and mortality. RESULTS: A total of 591 patients were enrolled, with a mean (SD) age of 47.4 (26.5) years and 67% being male. Of the patients, 13.3% were coagulopathic at admission. Platelet count of 100 × 103/μL or less was an independent predictor of progression on RHCT (odd ratio [OR], 4; 95% confidence interval [CI], 1.7Y10), need for neurosurgical intervention (OR, 3.6; 95% CI, 1.2Y6.1), and mortality (OR, 2.6; 95% CI, 1.1Y4.8). INR was an independent predictor of progression on RHCT (OR, 2; 95% CI, 1.1Y4.3). CONCLUSION: Routine bedside coagulation parameters at admission play an important role in predicting outcomes in blunt TBI. Platelet count is the strongest predictor for progression of initial insult on RHCT, need for neurosurgical intervention, and mortality.

Original languageEnglish (US)
Pages (from-to)121-125
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Platelet Count
International Normalized Ratio
Odds Ratio
Head
Tomography
Confidence Intervals
Partial Thromboplastin Time
Mortality
Traumatic Intracranial Hemorrhage
Anticoagulants
Cohort Studies
Outcome Assessment (Health Care)
Traumatic Brain Injury

Keywords

  • Coagulopathy and platelet count
  • Mortality
  • Neurosurgical intervention
  • Progression of intracranial hemorrhage
  • Traumatic brain injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Acquired coagulopathy of traumatic brain injury defined by routine laboratory tests : Which laboratory values matter? / Joseph, Bellal; Aziz, Hassan; Zangbar, Bardiya; Kulvatunyou, Narong; Pandit, Viraj; OKeeffe, Terence; Tang, Andrew; Wynne, Julie; Friese, Randall S.; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 1, 01.01.2014, p. 121-125.

Research output: Contribution to journalArticle

Joseph, Bellal ; Aziz, Hassan ; Zangbar, Bardiya ; Kulvatunyou, Narong ; Pandit, Viraj ; OKeeffe, Terence ; Tang, Andrew ; Wynne, Julie ; Friese, Randall S. ; Rhee, Peter. / Acquired coagulopathy of traumatic brain injury defined by routine laboratory tests : Which laboratory values matter?. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 1. pp. 121-125.
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abstract = "BACKGROUND: Coagulopathy is a major determinant of disability and death in patients with traumatic intracranial hemorrhage. However, the correlation between coagulopathy defined by routine coagulation tests and clinical outcomes in traumatic brain injury (TBI) is not well defined. The aim of our study was to determine the effect of coagulopathy diagnosed by routine laboratory tests on outcomes in TBI patients. METHODS: We performed a retrospective cohort analysis of all isolated TBI patients exclusive of prehospital antiplatelet and anticoagulants with coagulation tests, namely, international normalized ratio (INR), platelet count, and partial thromboplastin time at admission. We defined coagulopathy by an INR of 1.5 or greater, partial thromboplastin time of 35 or greater, or platelet count of 100 × 103/μL or less. Outcome measures were progression on repeat head computed tomography (RHCT), need for neurosurgical intervention, and mortality. RESULTS: A total of 591 patients were enrolled, with a mean (SD) age of 47.4 (26.5) years and 67{\%} being male. Of the patients, 13.3{\%} were coagulopathic at admission. Platelet count of 100 × 103/μL or less was an independent predictor of progression on RHCT (odd ratio [OR], 4; 95{\%} confidence interval [CI], 1.7Y10), need for neurosurgical intervention (OR, 3.6; 95{\%} CI, 1.2Y6.1), and mortality (OR, 2.6; 95{\%} CI, 1.1Y4.8). INR was an independent predictor of progression on RHCT (OR, 2; 95{\%} CI, 1.1Y4.3). CONCLUSION: Routine bedside coagulation parameters at admission play an important role in predicting outcomes in blunt TBI. Platelet count is the strongest predictor for progression of initial insult on RHCT, need for neurosurgical intervention, and mortality.",
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AU - Joseph, Bellal

AU - Aziz, Hassan

AU - Zangbar, Bardiya

AU - Kulvatunyou, Narong

AU - Pandit, Viraj

AU - OKeeffe, Terence

AU - Tang, Andrew

AU - Wynne, Julie

AU - Friese, Randall S.

AU - Rhee, Peter

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N2 - BACKGROUND: Coagulopathy is a major determinant of disability and death in patients with traumatic intracranial hemorrhage. However, the correlation between coagulopathy defined by routine coagulation tests and clinical outcomes in traumatic brain injury (TBI) is not well defined. The aim of our study was to determine the effect of coagulopathy diagnosed by routine laboratory tests on outcomes in TBI patients. METHODS: We performed a retrospective cohort analysis of all isolated TBI patients exclusive of prehospital antiplatelet and anticoagulants with coagulation tests, namely, international normalized ratio (INR), platelet count, and partial thromboplastin time at admission. We defined coagulopathy by an INR of 1.5 or greater, partial thromboplastin time of 35 or greater, or platelet count of 100 × 103/μL or less. Outcome measures were progression on repeat head computed tomography (RHCT), need for neurosurgical intervention, and mortality. RESULTS: A total of 591 patients were enrolled, with a mean (SD) age of 47.4 (26.5) years and 67% being male. Of the patients, 13.3% were coagulopathic at admission. Platelet count of 100 × 103/μL or less was an independent predictor of progression on RHCT (odd ratio [OR], 4; 95% confidence interval [CI], 1.7Y10), need for neurosurgical intervention (OR, 3.6; 95% CI, 1.2Y6.1), and mortality (OR, 2.6; 95% CI, 1.1Y4.8). INR was an independent predictor of progression on RHCT (OR, 2; 95% CI, 1.1Y4.3). CONCLUSION: Routine bedside coagulation parameters at admission play an important role in predicting outcomes in blunt TBI. Platelet count is the strongest predictor for progression of initial insult on RHCT, need for neurosurgical intervention, and mortality.

AB - BACKGROUND: Coagulopathy is a major determinant of disability and death in patients with traumatic intracranial hemorrhage. However, the correlation between coagulopathy defined by routine coagulation tests and clinical outcomes in traumatic brain injury (TBI) is not well defined. The aim of our study was to determine the effect of coagulopathy diagnosed by routine laboratory tests on outcomes in TBI patients. METHODS: We performed a retrospective cohort analysis of all isolated TBI patients exclusive of prehospital antiplatelet and anticoagulants with coagulation tests, namely, international normalized ratio (INR), platelet count, and partial thromboplastin time at admission. We defined coagulopathy by an INR of 1.5 or greater, partial thromboplastin time of 35 or greater, or platelet count of 100 × 103/μL or less. Outcome measures were progression on repeat head computed tomography (RHCT), need for neurosurgical intervention, and mortality. RESULTS: A total of 591 patients were enrolled, with a mean (SD) age of 47.4 (26.5) years and 67% being male. Of the patients, 13.3% were coagulopathic at admission. Platelet count of 100 × 103/μL or less was an independent predictor of progression on RHCT (odd ratio [OR], 4; 95% confidence interval [CI], 1.7Y10), need for neurosurgical intervention (OR, 3.6; 95% CI, 1.2Y6.1), and mortality (OR, 2.6; 95% CI, 1.1Y4.8). INR was an independent predictor of progression on RHCT (OR, 2; 95% CI, 1.1Y4.3). CONCLUSION: Routine bedside coagulation parameters at admission play an important role in predicting outcomes in blunt TBI. Platelet count is the strongest predictor for progression of initial insult on RHCT, need for neurosurgical intervention, and mortality.

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KW - Progression of intracranial hemorrhage

KW - Traumatic brain injury

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