Coagulopathy in acute head injury-a study of its role as a prognostic indicator

Abstract

The aim of this investigation was to determine the prognostic value of coagulation abnormalities in a defined subset of patients with acute head injury. Prothrombin time, accelerated partial thromboplastin time (APTT), thrombin clotting time, fibrinogen assay, platelet count, fibrin degradation products (FDP) were assayed in 204 patients with acute closed head injury. Their values were graded on a score 0-3 and the sum score for each patient regarded as the disseminated intravascular coagulation (DIC) score. Moderate to severe DIC scores were evident in 38% of the cohort. At least one parameter was abnormal in 71% of patients. The DIC score correlated inversely with the Glasgow coma score (GCS) (p < 0.0001). In the GCS 13-15 subset, FDP scores were significant predictors of poor outcome (p < 0.001). In the GCS 6-12 subset, the APTT score (p < 0.001), and DIC score (p < 0.0001) predicted an adverse outcome. The DIC scores were significantly abnormal in most patients who had a poor outcome, without evidence of adverse predictors on CT. Logistic regression analysis confirmed the independent predictive capacity of APTT, FDP and DIC scores when values for GCS were fixed. Abnormal haemostatic parameters may enhance the predictive ability in subsets of patients with acute head injury defined by clinical or CT predictors.

The Influence of Hemocoagulation Disorders on the Development of Posttraumatic Cerebral Infarction and Outcome in Patients with Moderate or Severe Head Trauma

“…The results of the multivariate analysis demonstrated that lower GCS, abnormal APTT and fibrinogen, elevated D-dimer, and higher DIC scores independently correlated to an increased risk of poor prognosis in patients with moderate to severe TBI, which is consistent with significant evidence in the literatures [8–11]. Selladurai et al showed DIC scores to correlate inversely with GCS and on logistic regression analysis showed APTT, fibrin degradation products, and DIC scores to be independent predictors of outcome when controlling for GCS [8]. Kuo et al demonstrated that coagulation state in head injury patients within 24 h after injury is of value in determining the outcome, and modified coagulopathy score > or = 4 is a good predictor to evaluate mortality rate [9].…”

“…A number of literatures demonstrate that posttraumatic coagulopathy appears to be linked to secondary cerebral insults and often results in a poor clinical prognosis [8–11]. Cerebral infarction has been recognized as a potential secondary injury after brain trauma.…”

Coagulopathy as prognostic marker in acute traumatic brain injury

“…The reported incidence ranges between 10 and 97%. [101112131415] This wide variation in incidence among various studies could be attributed to different criteria used by different authors to define coagulopathy (as no standard definition is available so far), varying inclusion criteria, and varying severity of the head trauma among different studies.…”

Coagulopathie aigue précoce des traumatismes crâniens graves: mortalité et facteurs pronostiques

“…Cliniquement, le risque d'une évolution défavorable (Glasgow Outcome Scale à 1-3) en présence d'une CoT est estimé à un odds ratio de 36.3 (95%CI: 8.7-70.5), et de décès à 9.4 (IC 95%: 7,6-11,6) [18], en plus le GCS bas est défini comme un prédicteur indépendant de mortalité [19]. Biologiquement, Olson et al [18] et Selladurai et al [20] ont démontré que le produit de dégradation de la fibrine (PDF) prédit un mauvais pronostic indépendamment des autres variables, et le pronostic s'aggrave au fur et à mesure de l'augmentation du PDF. Le temps de la prothrombine a été révélé aussi comme un facteur pronostique indépendant par l'étude IMPACT (International Mission for Prognosis And Clinical Trial) [21].…”