Lindley E Folkerson1, Duncan Sloan2, Elizabeth Davis2, Ryan S Kitagawa3, Bryan A Cotton2, John B Holcomb2, Jeffrey S Tomasek2, Charles E Wade4. 1. Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX, United States; Department of Surgery, University of Texas Health Science Center, Houston, TX, United States; Department of Emergency Medicine, University of Texas Health Science Center, Houston, TX, United States. 2. Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX, United States; Department of Surgery, University of Texas Health Science Center, Houston, TX, United States. 3. Department of Neurosurgery, University of Texas Health Science Center, Houston, TX, United States. 4. Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX, United States; Department of Surgery, University of Texas Health Science Center, Houston, TX, United States. Electronic address: Charles.E.Wade@uth.tmc.edu.
Abstract
STUDY HYPOTHESIS: Traumatic brain injury (TBI) is a leading cause of mortality with penetrating TBI (p-TBI) patients having worse outcomes. These patients are more likely to be coagulopathic than blunt TBI (b-TBI) patients, thus we hypothesize that coagulopathy would be an early predictor of mortality. METHODS: We identified highest-level trauma activation patients who underwent an admission head CT and had ICU admission orders from August 2009-May 2013, excluding those with polytrauma and anticoagulant use. Rapid thrombelastography (rTEG) was obtained after emergency department (ED) arrival and coagulopathy was defined as follows: ACT≥128s, KT≥2.5s, angle≤56°, MA≤55mm, LY-30≥3.0% or platelet count≤150,000/μL. Regression modeling was used to assess the association of coagulopathy on mortality. RESULTS: 1086 patients with head CT scans performed and ICU admission orders were reviewed. After exclusion criteria were met, 347 patients with isolated TBI were analyzed-99 (29%) with p-TBI and 248 (71%) with b-TBI. Patients with p-TBI had a higher mortality (41% vs. 10%, p<0.0001) and a greater incidence of coagulopathy (64% vs. 51%, p<0.003). After dichotomizing p-TBI patients by mortality, patients who died were younger and were more coagulopathic. When adjusting for factors available on ED arrival, coagulopathy was found to be an early predictor of mortality (OR 3.99, 95% CI 1.37, 11.72, p-value=0.012). CONCLUSIONS: This study demonstrates that p-TBI patients with significant coagulopathy have a poor prognosis. Coagulopathy, in conjunction with other factors, can be used to earlier identify p-TBI patients with worse outcomes and represents a possible area for intervention.
STUDY HYPOTHESIS: Traumatic brain injury (TBI) is a leading cause of mortality with penetrating TBI (p-TBI) patients having worse outcomes. These patients are more likely to be coagulopathic than blunt TBI (b-TBI) patients, thus we hypothesize that coagulopathy would be an early predictor of mortality. METHODS: We identified highest-level trauma activation patients who underwent an admission head CT and had ICU admission orders from August 2009-May 2013, excluding those with polytrauma and anticoagulant use. Rapid thrombelastography (rTEG) was obtained after emergency department (ED) arrival and coagulopathy was defined as follows: ACT≥128s, KT≥2.5s, angle≤56°, MA≤55mm, LY-30≥3.0% or platelet count≤150,000/μL. Regression modeling was used to assess the association of coagulopathy on mortality. RESULTS: 1086 patients with head CT scans performed and ICU admission orders were reviewed. After exclusion criteria were met, 347 patients with isolated TBI were analyzed-99 (29%) with p-TBI and 248 (71%) with b-TBI. Patients with p-TBI had a higher mortality (41% vs. 10%, p<0.0001) and a greater incidence of coagulopathy (64% vs. 51%, p<0.003). After dichotomizing p-TBIpatients by mortality, patients who died were younger and were more coagulopathic. When adjusting for factors available on ED arrival, coagulopathy was found to be an early predictor of mortality (OR 3.99, 95% CI 1.37, 11.72, p-value=0.012). CONCLUSIONS: This study demonstrates that p-TBIpatients with significant coagulopathy have a poor prognosis. Coagulopathy, in conjunction with other factors, can be used to earlier identify p-TBIpatients with worse outcomes and represents a possible area for intervention.
Authors: Ali Mansour; Andrea Loggini; Fernando D Goldenberg; Christopher Kramer; Andrew M Naidech; Faten El Ammar; Valentina Vasenina; Brandyn Castro; Paramita Das; Peleg M Horowitz; Theodore Karrison; Tanya Zakrison; David Hampton; Selwyn O Rogers; Christos Lazaridis Journal: J Neurotrauma Date: 2021-01-20 Impact factor: 4.869
Authors: D Bieler; E Kollig; L Hackenberg; J H Rathjen; R Lefering; A Franke Journal: Scand J Trauma Resusc Emerg Med Date: 2021-06-13 Impact factor: 2.953