Effect Of Coagulation On The Prognosis Of Acute Closed Traumatic Brain Injury

The existing diagnosis and treatment modes for traumatic brain injury (TBI)emphasized the intervention explicit on physiological and pathological disorders, but theimplicit pathophysiological processes after TBI did not attract adequate attention, thusmaking it difficult to decide effective preventive treatments prior to the development ofadvanced brain damage. Therefore, research on characteristic predictors of advanced braindamage after TBI should be in favor of early prognostic evaluation and prediction, therebysupporting prevention and treatment of susceptible clinical events after TBI. Objective: Toconfirm the predictive value of the early coagulation index after TBI on advanced braininjury and prognosis. Methods: From March2011to October2012,450TBI patients wereregistered in our hospital from which384single and closed TBI patients were involved inthis study according to the inclusion criteria. The study group contained252males and132females and the average age was37.24±16.43years old, the oldest being an88yearsold and the youngest10years old patient. The traumata included epidural and subduralhematoma, cerebral contusion, brain stem injury as well as subarachnoid hemorrhage, whilethe correlation between early coagulation index and traumatic brain injury prognosis wasindependently analyzed. From the384acute closed TBI patients, who were admitted to ourhospital within24hours after brain injury, the Hospital admission score (GCS score), PTtime, APTT time, FIB, D-Dimer and platelet counts were monitored and correlations withprognosis (GOS score) have been analyzed using a nonparametric and multiple linearregression tests. Results: The GCS scores were significantly correlated with prognoses ofepidural and subdural hematoma, cerebral contusions, brain stem injuries and subarachnoidhemorrhages (P＜0.05). The D-Dimer and FIB were significantly correlated with theprognosis of cerebral contusion and subdural hematoma (P＜0.05) and the PT hadsignificant effect on the prognosis of subarachnoid hemorrhage (P＜0.05), while the FIBhad a significant effect on the prognosis of epidural hematoma (P＜0.05). The correlationdegrees between coagulation index and prognoses for different kind of TBIs were different,being highest for brain stem injuries, followed orderly by subarachnoid hemorrhages,cerebral contusion, subdural hematoma and epidural hematoma. Conclusions: The Hospitaladmission score had a significant prediction value for the prognoses of each type of TBIand the D-Dimer had a relative stable prediction value for the prognosis of severecraniocerebral injuries in case its value was5times or even higher than the normal value,with significantly increased risk of death then. The prediction value of the coagulationindex on prognoses varied with the different types of TBI and generally the more seriousthe traumatic brain injury was, the more obvious was the correlation between coagulationindex and prognosis. Because correlations between coagulation index and prognoses of various craniocerebral trauma types were not uniform, more precise coagulation disordertests and dynamic continuous monitoring should be applied to analyze the exact degree ofcoagulopathy after TBI.