The association of coagulopathy and traumatic brain injury in patients with isolated head injury.
The emergence of prothrombotic agents (e.g. activated factor VII) to treat traumatic brain injury (TBI) requires a better understanding of the association of coagulopathy with isolated head injury (IHI).


OBJECTIVE
To investigate the association of IHI and coagulopathy.


METHODS
Prospective, observational study in an urban level I trauma center.


METHODS
Adult (> or = 13 years of age) patients with IHI.


METHODS
patients with known coagulopathies or on anticoagulant therapy.


METHODS
TBI (head abbreviated injury severity score > 2, or brain hematoma on CT scan), age, gender, mechanism of injury, Glasgow Coma Score (GCS), and loss of consciousness (LOC).


METHODS
coagulopathy defined as elevated International Normalized Ratio (INR > 1.3) or activated partial thromboplastin time (PTT) greater than 34 s. We divided IHI subjects into two groups of patients with and without TBI.


METHODS
Fisher's exact test and Mann-Whitney U were used to compare data where appropriate (alpha: 0.05, two-tailed).


RESULTS
From July 2005 to December 2006, 276 patients with IHI were studied. The median age was 35 years (interquartile range: 25-52) with a 79% male predominance and 88% blunt trauma. Eight percent (95% CI, 5-12%) of patients had coagulopathy. The rate of coagulopathy in TBI patients (17%) was significantly higher than non-TBI patients (6%) (11% difference, 95% CI, 3-20%]. The relative risk of coagulopathy in TBI patients was 2.9 (95% CI, 1.3-6.6).


CONCLUSIONS
Coagulopathy as defined by elevated INR and/or PTT is associated with TBI after isolated head injury.
Zehtabchi
Shahriar
S
Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States. szehtabchi@yahoo.com
Soghoian
Samara
S
Liu
Yiju
Y
Carmody
Kristin
K
Shah
Lekha
L
Whittaker
Brian
B
Sinert
Richard
R
D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology*; D001930:Brain Injuries / Q000209:etiology*; D006259:Craniocerebral Trauma / Q000150:complications* / Q000628:therapy*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D014474:Unconsciousness