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Neurocritical Care
Published in: Neurocritical Care 2/2010

01-04-2010 | Original Article

Acute Coagulopathy in Isolated Blunt Traumatic Brain Injury

Authors: Arasch Wafaisade, Rolf Lefering, Thorsten Tjardes, Sebastian Wutzler, Christian Simanski, Thomas Paffrath, Philipp Fischer, Bertil Bouillon, Marc Maegele, Trauma Registry of DGU

Published in: Neurocritical Care | Issue 2/2010

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Abstract

Background

The role of acute coagulopathy after traumatic brain injury (TBI) on outcome has gained increasing appreciation over the recent years. This study was conducted to assess the frequency, outcome, and risk factors associated with this complication.

Patients and Methods

Using the large, multi-center population-based Trauma Registry of the German Society for Trauma Surgery (TR-DGU), we retrospectively analyzed adult patients with isolated blunt TBI (intracranial AISHEAD ≥ 3 and extracranial AIS scores <3) for the presence of acute post-traumatic coagulopathy upon emergency room (ER) arrival. Coagulopathy was defined as prothrombin time test (Quick’s value) <70% and/or platelets < 100,000/μl.

Results

From a total of 3,114 eligible patients with isolated TBI, 706 (22.7%) presented with coagulopathy upon ER arrival. Coagulopathy was associated with higher rates of craniotomies (P = 0.02), of single and multiple organ failure and with less intubation-free days. In surviving patients, ICU length of stay and hospital length of stay were significantly longer, if coagulopathy had been present at admission. The overall hospital mortality was 50.4% (n = 356) in patients with coagulopathy vs. 17.3% (n = 417) in non-coagulopathic patients (all P < 0.001). Multivariate analysis identified AISHEAD severity grade, GCS ≤ 8 at scene, the presence of hypotension at scene and/or at ER, pre-hospital i.v.-fluids ≥2,000 ml and age ≥75 years as independent risk factors for coagulopathy after TBI. Acute coagulopathy in TBI had an adjusted odds ratio for hospital mortality of 2.97 (CI95: 2.30–3.85; P < 0.001).

Conclusion

Coagulopathy upon ER admission is frequent after isolated blunt TBI and represents a powerful, independent predictor related to prognosis. Future research should aim to determine the beneficial effects of early treatment of TBI-associated coagulopathy.
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Metadata
Title
Acute Coagulopathy in Isolated Blunt Traumatic Brain Injury
Authors
Arasch Wafaisade
Rolf Lefering
Thorsten Tjardes
Sebastian Wutzler
Christian Simanski
Thomas Paffrath
Philipp Fischer
Bertil Bouillon
Marc Maegele
Trauma Registry of DGU
Publication date
01-04-2010
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 2/2010
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-009-9281-1

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