Daniel S Epstein1, Biswadev Mitra2, Gerard O'Reilly1, Jeffrey V Rosenfeld3, Peter A Cameron4. 1. Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia. 2. Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: biswadev.mitra@monash.edu. 3. Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia; Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia. 4. Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia; Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
Abstract
BACKGROUND AND OBJECTIVES: Acute traumatic coagulopathy (ATC) has been reported in the setting of isolated traumatic brain injury (iTBI) and associated with high mortality and poor outcomes. The aim of this systematic review was to examine the incidence and outcome of patients with ATC in the setting of iTBI. METHODS: We conducted a search of the MEDLINE database and Cochrane library, focused on subject headings and keywords involving coagulopathy and TBI. Design and results of each study were described. Studies were assessed for heterogeneity and the pooled incidence of ATC in the setting of iTBI determined. Reported outcomes were described. RESULTS: There were 22 studies selected for analysis. A statistically significant heterogeneity among the studies was observed (p<0.01). Using the random effects model the pooled proportion of patients with ATC in the setting of iTBI was 35.2% (95% CI: 29.0-41.4). Mortality of patients with ATC and iTBI ranged between 17% and 86%. Higher blood transfusion rates, longer hospital stays, longer ICU stays, decreased ventilator free days, higher rates of single and multiple organ failure and higher incidence of delayed injury and disability at discharge were reported among patients with ATC. CONCLUSIONS: ATC is commonly associated with iTBI and almost uniformly associated with worse outcomes. Any disorder of coagulation above the normal range appears to be associated with worse outcomes and therefore a clinically important target for management. Earlier identification of patients with ATC and iTBI, for recruitment into prospective trials, presents avenues for further research.
BACKGROUND AND OBJECTIVES: Acute traumatic coagulopathy (ATC) has been reported in the setting of isolated traumatic brain injury (iTBI) and associated with high mortality and poor outcomes. The aim of this systematic review was to examine the incidence and outcome of patients with ATC in the setting of iTBI. METHODS: We conducted a search of the MEDLINE database and Cochrane library, focused on subject headings and keywords involving coagulopathy and TBI. Design and results of each study were described. Studies were assessed for heterogeneity and the pooled incidence of ATC in the setting of iTBI determined. Reported outcomes were described. RESULTS: There were 22 studies selected for analysis. A statistically significant heterogeneity among the studies was observed (p<0.01). Using the random effects model the pooled proportion of patients with ATC in the setting of iTBI was 35.2% (95% CI: 29.0-41.4). Mortality of patients with ATC and iTBI ranged between 17% and 86%. Higher blood transfusion rates, longer hospital stays, longer ICU stays, decreased ventilator free days, higher rates of single and multiple organ failure and higher incidence of delayed injury and disability at discharge were reported among patients with ATC. CONCLUSIONS: ATC is commonly associated with iTBI and almost uniformly associated with worse outcomes. Any disorder of coagulation above the normal range appears to be associated with worse outcomes and therefore a clinically important target for management. Earlier identification of patients with ATC and iTBI, for recruitment into prospective trials, presents avenues for further research.
Authors: Matthew C Hernandez; Cornelius A Thiels; Johnathon M Aho; Elizabeth B Habermann; Martin D Zielinski; James A Stubbs; Donald H Jenkins; Scott P Zietlow Journal: J Trauma Acute Care Surg Date: 2017-09 Impact factor: 3.313
Authors: Jason M Samuels; Ernest E Moore; Christopher C Silliman; Anirban Banerjee; Mitchell J Cohen; Arsen Ghasabyan; James Chandler; Julia R Coleman; Angela Sauaia Journal: J Trauma Acute Care Surg Date: 2019-04 Impact factor: 3.313
Authors: Allison R Jones; Rakesh P Patel; Marisa B Marques; John P Donnelly; Russell L Griffin; Jean-Francois Pittet; Jeffrey D Kerby; Shannon W Stephens; Stacia M DeSantis; John R Hess; Henry E Wang Journal: Ann Emerg Med Date: 2018-11-15 Impact factor: 5.721