The Correlation Between Acute Traumatic Coagulation Disease And The Prognosis Of Craniocerebral Trauma Patients

Objective: Acute traumatic coagulopathy often occurs after craniocerebral trauma and is associated with the poor prognosis of the patients.The purpose of this study was to explore the relationship between the changes of clinical indicators and the incidence of acute traumatic coagulopathy,and the correlation with the severity and prognosis of acute coagulopathy,in addition,to analyze the factors that may lead to acute traumatic coagulopathy.Methods: We collected 310 patients with craniocerebral trauma admitted to the emergency department from October 2014 to September 2017 in The First Affiliated Hospital of Soochow University,and 113 patients with craniocerebral trauma admitted to department of neurosurgery of The Second Hospital of Lianyungang city from January 2017 to December 2017.The following conditions were recorded: age and gender,injury severity score(ISS),admission heart rate,systolic blood pressure,Glasgow Coma Scale(GCS),dyscoria,international normalized ratio(INR),fibrinogen,hemoglobin,platelet count,platelet distribution width(PDW),red cell distribution width(RDW),death time and hospitalization.According to the results of INR,the patients were divided into coagulopathy group and non coagulopathy group,and the difference of prognosis between the two groups patients was compared.Results: 1.Compared with the non coagulopathy group,the shock index,pupil abnormal ratio,red blood cell distribution width,craniocerebral operation and hospital mortality increased significantly in the coagulation group(P < 0.05).The GCS score,fibrinogen,hemoglobin and platelet count in coagulation group patients were significant lower than those in non coagulation group(P < 0.05).2.GCS score(OR:0.858,95%CI 0.768-0.959,P=0.007)and shock index(OR:1.042,95%CI 1.0010-1.074,P=0.009)at admission were independent risk factors for ATC in i TBI patients after admission.3.The sensitivity of shock index to the prediction of ATC in i TBI patients was 36% and the specificity was 88.5%,and the difference was statistically significant(P=0.005).The sensitivity of GCS to the prediction of ATC in i TBI patients was 66% and the specificity was 76.1%(P < 0.001).4.In our research,age(OR:1.051;95%CI:1.007-1.097;P=0.022),GCS(OR:0.674;95%CI:0.567-0.801;P < 0.001),INR ?1.2(OR:4.142 95%CI:1.471-11.665;P=0.007),platelet distribution width(OR:1.537;95%CI:1.104-2.138;P=0.011),red cell distribution width(OR:1.762;95%CI:1.123-2.765;P=0.014)were the independent risk factors of death in patients with i TBI in the hospital.Conclusion: 1.With INR?1.2 as the diagnostic standard of ATC,the possibility of death increased significantly in i TBI patients with ATC.2.The indexes of shock index and GCS score have certain value for the early prediction of the occurrence of ATC.3.Age,GCS score,RBC distribution width,and platelet distribution width at admission were independent risk factors for hospital death in i TBI patients.