North Pacific Surgical AssociationThrombelastography-identified coagulopathy is associated with increased morbidity and mortality after traumatic brain injury
Section snippets
Methods
This study was approved by the Institutional Review Board at Oregon Health and Science University. Because of the nature of the study, waiver of consent at time of enrollment was granted by the Institutional Review Board. Informed consent was obtained by all participants or their legal representatives once they were available.
Results
Sixty-nine patients were enrolled in the study. Admission characteristics of the patients enrolled in the study are shown in Table 1. When using an R time greater than 9 minutes to determine hypocoagulability certain characteristics differed significantly between the 2 groups. A prolonged R time was associated with greater injury severity determined by a higher ISS (P = .04), worsening head injury based on increased head AIS (P < .01), increased hemorrhage volume on admission head CT (P = .01),
Conclusions
In this study we examined the use of thrombelastography at time of admission in predicting clinical outcomes after traumatic brain injury. Although the overall patient characteristics were representative of the general trauma population we did note significant differences in certain characteristics between patients who had prolonged R time compared with those that did not. Patients who were hypocoagulable at admission had a higher degree of injury based on ISS. This was not unexpected because
References (23)
- et al.
Clinical value of serial computed tomography with severe head injury
Surg Neurol
(1983) - et al.
The association of coagulopathy and traumatic brain injury in patients with isolated head injury
Resuscitation
(2008) - et al.
Time course of coagulopathy in isolated severe traumatic brain injury
Injury
(2010) - et al.
Changes in transfusion therapy and reexploration rate after institution of a blood management program in cardiac surgical patients
J Cardiothorac Vasc Anesth
(1995) - et al.
Severe head injury and the risk of early death
J Neurol Neurosurg Psychiatry
(2006) - et al.
Clinical trials in head injury
J Neurotrauma
(2002) - et al.
Seven hundred fifty-three consecutive deaths in a level I trauma center: the argument for injury prevention
J Trauma
(2003) - et al.
The epidemiology of traumatic deathA population-based analysis
Arch Surg
(1993) - et al.
Enhanced specificity of prognosis in severe head injury
J Neurosurg
(1988) - et al.
Delayed brain injury after head trauma: significance of coagulopathy
Neurosurgery
(1992)
Serial computerized tomographic scanning and the prognosis of severe head injury
Neurosurgery
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