North Pacific Surgical Association
Thrombelastography-identified coagulopathy is associated with increased morbidity and mortality after traumatic brain injury

https://doi.org/10.1016/j.amjsurg.2011.12.011Get rights and content

Abstract

Background

The purpose of this study was to determine the relationship between coagulopathy and outcome after traumatic brain injury.

Methods

Patients admitted with a traumatic brain injury were enrolled prospectively and admission blood samples were obtained for kaolin-activated thrombelastogram and standard coagulation assays. Demographic and clinical data were obtained for analysis.

Results

Sixty-nine patients were included in the analysis. A total of 8.7% of subjects showed hypocoagulability based on a prolonged time to clot formation (R time, > 9 min). The mortality rate was significantly higher in subjects with a prolonged R time at admission (50.0% vs 11.7%). Patients with a prolonged R time also had significantly fewer intensive care unit–free days (8 vs 27 d), hospital-free days (5 vs 24 d), and increased incidence of neurosurgical intervention (83.3% vs 34.9%).

Conclusions

Hypocoagulability as shown by thrombelastography after traumatic brain injury is associated with worse outcomes and an increased incidence of neurosurgical intervention.

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

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  • Cited by (63)

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