Validating the incidence of coagulopathy and disseminated intravascular coagulation in patients with traumatic brain injury – analysis of 242 cases

Sun, Yirui; Wang, Jianqing; Wu, Xing; Xi, Caihua; Gai, Yanting; Liu, Hua; Yuan, Qiang; Wang, Ersong; Gao, Liang; Hu, Jin; Zhou, Lei

doi:10.3109/02688697.2011.552650

Cited by 72 publications

(51 citation statements)

References 41 publications

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“…Microthrombosis was also observed in brains of surgical specimens of human cerebral contusions, after FPI, and after head rotational acceleration injuries (Dietrich et al, 1996a;Stein and Smith, 2004;Stein et al, 2002). In this regard, coagulation abnormalities can be an independent predictor of clinical outcome (Saggar et al, 2009;Sun et al, 2011). In the present study, pre/post-traumatic hyperthermia may induce subclinical changes in the coagulation system that could be enhanced by the mild traumatic insult.…”

supporting

confidence: 50%

Mild Hyperthermia Worsens the Neuropathological Damage Associated with Mild Traumatic Brain Injury in Rats

Sakurai

Atkins

Alonso

et al. 2012

Journal of Neurotrauma

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The effects of slight variations in brain temperature on the pathophysiological consequences of acute brain injury have been extensively described in models of moderate and severe traumatic brain injury (TBI). In contrast, limited information is available regarding the potential consequences of temperature elevations on outcome following mild TBI (mTBI) or concussions. One potential confounding variable with mTBI is the presence of elevated body temperature that occurs in the civilian or military populations due to hot environments combined with exercise or other forms of physical exertion. We therefore determined the histopathological effects of preand post-traumatic hyperthermia (39°C) on mTBI. Adult male Sprague-Dawley rats were divided into 3 groups: pre/post-traumatic hyperthermia, post-traumatic hyperthermia alone for 2 h, and normothermia (37°C). The pre/post-hyperthermia group was treated with hyperthermia starting 15 min before mild parasagittal fluidpercussion brain injury (1.4-1.6 atm), with the temperature elevation extending for 2 h after trauma. At 72 h after mTBI, the rats were perfusion-fixed for quantitative histopathological evaluation. Contusion areas and volumes were significantly larger in the pre/post-hyperthermia treatment group compared to the post-hyperthermia and normothermic groups. In addition, pre/post-traumatic hyperthermia caused the most severe loss of NeuNpositive cells in the dentate hilus compared to normothermia. These neuropathological results demonstrate that relatively mild elevations in temperature associated with peri-traumatic events may affect the long-term functional consequences of mTBI. Because individuals exhibiting mildly elevated core temperatures may be predisposed to aggravated brain damage after mTBI or concussion, precautions should be introduced to target this important physiological variable.

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supporting

confidence: 50%

Mild Hyperthermia Worsens the Neuropathological Damage Associated with Mild Traumatic Brain Injury in Rats

Sakurai

Atkins

Alonso

et al. 2012

Journal of Neurotrauma

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“…More recent studies of isolated severe TBI by Lustenberger and colleagues (Lustenberger et al, 2010a(Lustenberger et al, ,2010b found that up to 45% of these patients become coagulopathic, a finding that is in accord with a meta-analysis of 34 studies done by Harhangi and associates (Harhangi et al, 2008; weighted average of 32.7%). Coagulopathy can develop up to 5 days after injury, and the incidence appears to be linearly correlated with increasing severity of injury (Lustenberger et al, 2010a(Lustenberger et al, ,2010bSun et al, 2011).…”

Section: Coagulopathy In Tbimentioning

confidence: 97%

Hemorrhagic Progression of a Contusion after Traumatic Brain Injury: A Review

Kurland

Hong

Aarabi

et al. 2012

Journal of Neurotrauma

291

220

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Кафедра нейрохірургії, Національна медична академія післядипломної освіти імені П.Л. Шупика МОЗ України, Київ, Україна 2 Нейрохірургічне відділення №1, Київська міська клінічна лікарня швидкої медичної допомоги, Київ, Україна Вторинна геморагічна прогресія вогнищ забою головного мозку у пацієнтів при черепно-мозковій травмі Вступ. Вторинні післятравматичні зміни головного мозку (ГМ) часто є визначальними в клінічному перебігу черепно-мозкової травми (ЧМТ). Попередження, виявлення та визначення лікувальної тактики при вторинній геморагічній прогресії забою (ВГПЗ) ГМ актуальні для нейротравматології. Матеріали і методи. Проаналізовані результати лікування потерпілих з ЧМТ, у яких діагностований забій ГМ. Результати. Встановлено, що ВГПЗ виникає у 50% пацієнтів при ЧМТ, як у місцях первинного ушкодження ГМ, так і у віддалених зонах за принципом протиудару протягом 12 год, хоча може виникати і через 3-4 доби після травми. ВГПЗ часто виявляють у пацієнтів з субдуральною гематомою (СДГ). Чим більше вогнище забою, тим більша ймовірність його прогресії та необхідності хірургічної декомпресії. Висновки. ВГПЗ є одним з найважливіших ускладнень після ЧМТ, пов'язана з значним підвищенням ризику клінічного погіршення. Лікувальна тактика залежить від вираженості впливу на навколишні структури та проявів компресійно-дислокаційного синдрому. Ключові слова: тяжка черепно-мозкова травма, забій головного мозку, вторинна геморагічна прогресія вогнищ забою, внутрішньочерепний тиск, ішемічні розлади. Introduction. Secondary posttraumatic changes of the brain often are determining in the clinical flow of traumatic brain injury (TBI). Prevention, detection and determination of treatment strategy at secondary hemorrhagic progression of contusion (SHPC) are very actual for neurotraumatology. Materials and methods. The results of 110 injured persons with TBI were analyzed. Results. It was found that SHPC occurs in 50% patients with TBI, as in areas of primary brain damage as in remote areas on the other side of the brain during 12 h ad also after 3-4 days. SHPC often is revealed in patients with subdural hematoma. The bigger contusion foci, the higher the probability of their progression and the need of surgical decompression. Conclusions. SHPC is one of most important TBI complications associated with considerable risk of clinical deterioration and serious cause of morbidity and lethality. Treatment tactics depends on severity of volumetric effect on surrounding brain structures and manifestations of compression-dislocation syndrome.

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“…All other causes of coagulopathy were excluded in that study. 38 A more recent multicenter study 39 demonstrated that both delayed and early sustained coagulopathy in isolated TBI correlates with more abnormalities on initial CT, hematomas >25 ml and worse outcomes in comparison with early short-term coagulopathy.…”

Section: Tbi Associated Coagulopathymentioning

confidence: 99%

Epidural Hematoma Treated Conservatively: When to Expect the Worst

Basamh

Robert

Lamoureux

et al. 2015

Can. J. Neurol. Sci.

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Background: The Brain Trauma Foundation's 2006 surgical guidelines have objectively defined the epidural hematoma (EDH) patients who can be treated conservatively. Since then, the literature has not provided adequate clues to identify patients who are at higher risk for EDH progression (EDHP) and conversion to surgical therapy. The goal of our study was to identify those patients. Methods: We carried a retrospective review over a 5-year period of all EDH who were initially triaged for conservative management. Demographic data, injury severity and history, neurological status, use of anticoagulants or anti-platelets, radiological parameters, conversion to surgery and its timing, and Glasgow Outcome Scale were analyzed. Bivariate association and further logistic regression were used to point out the significant predictors of EDHP and conversion to surgery. Results: 125 patients (75% of all EDH) were included. The mean age was 39.1 years. The brain injury was mild in 62.4% of our sample and severe in 14.4%. Only 11.2% of the patients required surgery. Statistical comparison showed that younger age (p < 0.0001) and coagulopathy (p = 0.009) were the only significant factors for conversion to surgery. There was no difference in outcomes between patients who had EDHP and those who did not. Conclusions: Most traumatic EDH are not surgical at presentation. The rate of conversion to surgery is low. Significant predictors of EDHP are coagulopathy and younger age. These patients need closer observation because of a higher risk of EDHP. Outcome of surgical conversion was similar to successful conservative management.RÉSUMÉ: Hématome épidural traité de façon conservatrice : quand s'attendre au pire. Contexte : Les lignes directrices chirurgicales de la Brain Trauma Foundation de 2006 ont défini objectivement les patients atteints d'un hématome épidural (HÉD) qui peuvent être traités de façon conservatrice. Depuis lors, il n'existe pas dans la littérature d'indices adéquats pour identifier les patients qui sont à plus haut risque de progression de l'HÉD et chez qui un traitement chirurgical doit être envisagé. Le but de notre étude était d'identifier ces patients. Méthode : Nous avons effectué une revue rétrospective sur une période de 5 ans des dossiers de tous les patients atteints d'un HÉD qui ont été assignés initialement au traitement conservateur. Nous avons analysé les données démographiques, la sévérité de la lésion et son historique, l'état neurologique, la prise d'anticoagulants ou d'antiplaquettaires, les paramètres radiologiques, le recours à un traitement chirurgical et le moment où il a été réalisé ainsi que le score au Glasgow Outcome Scale. L'analyse bivariée ainsi que l'analyse de régression logistique ont été utilisées pour déterminer les facteurs de prédiction significatifs de la progression de l'HÉD et du recours à la chirurgie. Résultats : Cent vingt-cinq patients (75% des patients atteints d'un HÉD) ont été inclus dans l'étude. L'âge moyen des patients était de 39,1 ans. La lésion cérébrale étai...

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Validating the incidence of coagulopathy and disseminated intravascular coagulation in patients with traumatic brain injury – analysis of 242 cases

Abstract: Coagulation changes, particularly the incidence of DIC, may occur within 6 h after TBI and are more pronounced in patients with severe injuries and poor outcome. PT, D-DT levels and more comprehensively a DIC scores may be useful prognostic indicators in patients with TBI.

Cited by 72 publications

References 41 publications

Mild Hyperthermia Worsens the Neuropathological Damage Associated with Mild Traumatic Brain Injury in Rats

Mild Hyperthermia Worsens the Neuropathological Damage Associated with Mild Traumatic Brain Injury in Rats

Hemorrhagic Progression of a Contusion after Traumatic Brain Injury: A Review

Epidural Hematoma Treated Conservatively: When to Expect the Worst

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