Clinical Analysis Of Acute Traumatic Coagulopathy In Middle-aged And Elderly Patients With Traumatic Brain Injury

OBJECTIVE:The purpose of this study was to determine whether acute isolated traumatic brain injury is an independent risk factor for acute traumatic coagulopathy and to assess outcomes and risk factors associated with this complication.METHODS:A retrospective collection of 345 patients who met the study criteria during the period from 2013-06-01 to 2018-06-01 in the First Affiliated Hospital of Soochow University.Patients were divided into 3 groups according to the abbreviated injury scale(AIS score):simple traumatic brain injury group(iTBI group,head AIS>3 and all other parts of the body AIS<3);TBI combined with multiple trauma group(TBI+group,head AIS>3 and all other parts of the body AIS>3);severe multi-system trauma with non-TBI group(NTBI group,head AIS<3 and all other parts of the body AIS>3).The main outcomes were acute traumatic coagulopathy and progressive hemorrhagic injury.Different factors such as acute traumatic coagulation(ATC)and progressive hemorrhagic injury(PHI)were used to establish different multivariate logistic regression models to analyze the risk factors of ATC and PHI.RESULTS:A total of 345 eligible patients were included in the study,including 78 patients with traumatic brain injury(iTBI group)and 120 patients with TBI combined with multiple trauma(TBI+group);severe multi-system with non-TBI There were 147 cases in the trauma group(NTBI group).Patients in the TBI+group had the highest incidence of ATC(35.8%),and there was no significant increase in the incidence of iTBI-related ATC compared with NTBI patients with similar degrees of injury.The overall in-hospital mortality rate was 39.3%for patients with coagulopathy and 17.6%for non-coagulopathy patients(P<0.01).iTBI was not an independent risk factor for coagulopathy(OR 1.25;0.34-4.67 CI,P=0.73).Multivariate analysis identified ISS score,GCS scores?8,Shock index>1,and age>75 years were independent risk factors for coagulopathy after iTBI.Multivariate analysis determined that ISS score,PLT<100×10^9/L and INR>1.5 were ISS scoreindependently associated with PHI.CONCLUSION:1.iTBI is not an independent risk factor for coagulopathy,but the incidence of ATC is significantly increased in patients with TBI combined with multiple trauma.2.ISS score,GCS score:?8,Shock index>1,age>75 years is an independent risk factor for coagulopathy after trauma.3.ISS score,INR>1.5 and PLT<100×10^9/L are independent risk factors for PHI.