Changes Of Early Coagulopathy And Effect On Outcome In Patients With Traumatic Brain Injury

Objective:To study the early coagulation changes and clinical significance after traumatic brain injury.Methods:A retrospective analysis was performed on a prospective observational database containing 114 isolated and closed head trauma patients from 2007 January to December.The Glasgow Coma Score(GCS),head Abbreviated Injury Score(AIS)at the emergency department,Glasgow Outcome Score(GOS),Disseminated intravascular coagulation score(DICscore),the Intensive Care Unit Length of Stay(ICULOS)and Hospital Length of Stay(HLOS)were calculated and recorded.The early prothrombin time(PT),partial thromboplastin time(PTT),fibrinogen,platelet counts and D-dimer levels were measured.?~2 statistics,t-test,Spearman rank correlation and Logistic regression analysis were used to evaluated the effect of coagulopathy on the outcome and to indentify risk facters for bad outcome.Statistical significance was accepted at p=0.05.Results:A total of 114 patients met inclusion criteria.There were 88 males and 26 females,the median age in this group was 44.45±17.04 years(range from 5 to 87).According to CT scan,30 patients(26.32%)displayed progressive hemorrhage injury(PHI).The mean GCS and haed AIS in the emergency department was 9.93 and 3.82,respectively.Of the total 114 patients,47(41.2%)had mild head injury,20(17.5%)had morderate head injury,47(41.2%)had severe head injury.A total of 265 cranocerebral injury lesions were indentified in these patients including 41epidural hemorrhage(EDH),51subdural hemorrhages(SDH),64contusions(Cont),54subarachnoid hemorrhages(SAH),2 diffuse axonal injuries(DAI),3 intraventricular hemorrhages (IVH),and 57 skull fractures(FRA).The median of ICULOS and HLOS was(10.05±15.78)d and(19.59±16.79)d,respectively.Of the total 114 patients in this study 83(72.8%)surviored and 31(27.2%)died.The difference of PTT,D-dimer,GOS,ICULOS between mild and other groups were significant (p=0.05).The coagulopathy and trombocytopnia in morderate and severe head injury were 41.2%and 46.49%.61.3%patients whose head AIS=3 were indentified coagulopathy.Coagulopathy parameters were not correlated PHI but PHI was strongly related to ICULOS,HLOS and GOS((p＜0.01,p＜0.05,p＜0.05,respectively).Logistic regression analysis shew a marked negative relationship was found between GOS and AIS,PT,D-dimer,PLT and DICscore.Conlusion:Coagulopathy took place nearly immediately after brain injury.Every type of traumatic brain injury could lead to Coagulopathy and thrombocytopenia, especially in morderate and severe brain injury.The head AIS at emergency department could predict coagulopathy parameters.Early coagulopathy parameters did not predict PHI,but ICULOS,HLOS,GOS in PHI group were longer and worse than no PHI group. Although PT,PTT,PLT were in normal range in some patients,the early D-dimer and DIC score were marked strong with GOS(p＜0.01).