TY - JOUR
T1 - Acquired coagulopathy of traumatic brain injury defined by routine laboratory tests
T2 - Which laboratory values matter?
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
PY - 2014/1/1
Y1 - 2014/1/1
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.
KW - Coagulopathy and platelet count
KW - Mortality
KW - Neurosurgical intervention
KW - Progression of intracranial hemorrhage
KW - Traumatic brain injury
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U2 - 10.1097/TA.0b013e3182a9cc95
DO - 10.1097/TA.0b013e3182a9cc95
M3 - Article
AN - SCOPUS:84892152811
SN - 2163-0755
VL - 76
SP - 121
EP - 125
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1
ER -