INTRODUCTION: Patients with head injuries frequently have abnormal coagulation studies. Monitoring intracranial pressure (ICP) in head injured patients is common practice, but no best practice guidelines exist for coagulation parameters for ICP monitor placement. PURPOSE: To test the hypothesis that hemorrhagic complication rates from ICP monitor placement are low and that the use of FFP to correct coagulation parameters to "normal" is not indicated. METHODS: Retrospective review of all patients admitted to a Level I trauma center over a 3 year period, who underwent fiberoptic intraparenchymal ICP monitoring was undertaken. Inclusion criteria were coagulation studies (prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), platelet count) before ICP monitor placement and head CT scans to assess for hemorrhage before and after monitor placement. Data collected included age, Glasgow coma score (GCS), head region abbreviated injury score (H_AIS), time to ICP monitor placement, complications and outcomes. RESULTS: From 8/1/00 through 7/31/03, 5163 trauma patients were admitted, and 157 met inclusion criteria. Patients were stratified by INR, at the time of ICP placement as normal (0.8-1.2, 103 patients), borderline (1.3-1.6, 42 patients) and increased (>/=1.7, 12 patients). There was no difference between the groups in age, gender or H_AIS. Twenty two patients had component therapy to correct coagulopathy before ICP insertion, but 10 had INRs in the borderline group and 12 remained with INRs >/=1.7. Eleven patients had platelet counts 50,000-100,000 at ICP monitor placement, despite platelet transfusions. Time from admission to ICP monitor placement was significantly longer in patients who received component therapy (19.2 +/- 19.7 hours versus 8.8 +/- 13.9 hours, p < 0.002). Three patients had clinically insignificant, petechial hemorrhages (1.9%); one in each group, with INRs of 1.2, 1.3, and 2.5, respectively. CONCLUSIONS: In patients with INR </=1.6, hemorrhagic complications after ICP monitor placement were infrequent. The use of FFP to "normalize" INR below this threshold is not supported by this data and delays monitor placement.
INTRODUCTION:Patients with head injuries frequently have abnormal coagulation studies. Monitoring intracranial pressure (ICP) in head injured patients is common practice, but no best practice guidelines exist for coagulation parameters for ICP monitor placement. PURPOSE: To test the hypothesis that hemorrhagic complication rates from ICP monitor placement are low and that the use of FFP to correct coagulation parameters to "normal" is not indicated. METHODS: Retrospective review of all patients admitted to a Level I trauma center over a 3 year period, who underwent fiberoptic intraparenchymal ICP monitoring was undertaken. Inclusion criteria were coagulation studies (prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), platelet count) before ICP monitor placement and head CT scans to assess for hemorrhage before and after monitor placement. Data collected included age, Glasgow coma score (GCS), head region abbreviated injury score (H_AIS), time to ICP monitor placement, complications and outcomes. RESULTS: From 8/1/00 through 7/31/03, 5163 traumapatients were admitted, and 157 met inclusion criteria. Patients were stratified by INR, at the time of ICP placement as normal (0.8-1.2, 103 patients), borderline (1.3-1.6, 42 patients) and increased (>/=1.7, 12 patients). There was no difference between the groups in age, gender or H_AIS. Twenty two patients had component therapy to correct coagulopathy before ICP insertion, but 10 had INRs in the borderline group and 12 remained with INRs >/=1.7. Eleven patients had platelet counts 50,000-100,000 at ICP monitor placement, despite platelet transfusions. Time from admission to ICP monitor placement was significantly longer in patients who received component therapy (19.2 +/- 19.7 hours versus 8.8 +/- 13.9 hours, p < 0.002). Three patients had clinically insignificant, petechial hemorrhages (1.9%); one in each group, with INRs of 1.2, 1.3, and 2.5, respectively. CONCLUSIONS: In patients with INR </=1.6, hemorrhagic complications after ICP monitor placement were infrequent. The use of FFP to "normalize" INR below this threshold is not supported by this data and delays monitor placement.
Authors: Susan E Rowell; Ronald R Barbosa; Tori C Lennox; Kelly A Fair; Abigail J Rao; Samantha J Underwood; Martin A Schreiber Journal: J Trauma Acute Care Surg Date: 2014-12 Impact factor: 3.313
Authors: Robert Russell; David F Bauer; Susan M Goobie; Thorsten Haas; Marianne E Nellis; Daniel K Nishijima; Adam M Vogel; Jacques Lacroix Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.624
Authors: Marianne E Nellis; Kenneth E Remy; Jacques Lacroix; Jill M Cholette; Melania M Bembea; Robert T Russell; Marie E Steiner; Susan M Goobie; Adam M Vogel; Gemma Crighton; Stacey L Valentine; Meghan Delaney; Robert I Parker Journal: Pediatr Crit Care Med Date: 2022-01-01 Impact factor: 3.971
Authors: Benjamin E Szpila; Tezcan Ozrazgat-Baslanti; Jianyi Zhang; Jennifer Lanz; Ruth Davis; Annette Rebel; Erin Vanzant; Lori F Gentile; Alex G Cuenca; Darwin N Ang; Huazhi Liu; Lawrence Lottenberg; Peggy Marker; Marc Zumberg; Azra Bihorac; Frederick A Moore; Scott Brakenridge; Philip A Efron Journal: PLoS One Date: 2015-05-26 Impact factor: 3.240