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

Abstract

Objectives: To estimate the incidence of coagulopathy and disseminated intravascular coagulation (DIC) in patients with traumatic brain injury (TBI) and to investigate its relationship to patient outcome.

Design: A prospective observational study.

Measurements and main results. From January 2007 to June 2009, 242 consecutive adult patients with TBI seen in three independent hospitals were recruited. Glasgow Coma Score (GCS) on admission, platelet counts (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), d-dimer (D-DT) and DIC scores were recorded for each case on admission. Clinical outcome was measured according to the Glasgow Outcome Scale (GOS) at 3 months after injury. Statistical analysis was carried using Student's t-test, one-way analysis of variance (ANOVA), and Tudey test. Coagulation abnormalities were present in approximately 50% of patients with TBI. Prolonged PT and increased D-DT and FIB levels occurred in patients with more severe brain injury and poorer outcome, and these findings were statistically significant.

Conclusions: 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.

Key words:

• Traumatic brain injury (TBI)
• head injury
• coagulopathy
• disseminated intravascular coagulation (DIC)
• neurological outcome

Acknowledgements

The study is funded by The National Natural Science Foundation of China (81000518, 30770824); China Postdoctoral Science Foundation funded project (201003237); the Scientific Research Foundation for the Returned Overseas Chinese Scholars, Ministry of Education of China; Shanghai Pujiang Program (09PJ1408300); The Science and Technology Commission of Shanghai Municipality project (10JC1402300). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors report no conflicts of interest. The authors thank Hengli Tian, Haijun Yao, Yong Liu, Yi Jin, Xuehai Wu for supporting this study.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.