title: The association of coagulopathy and traumatic brain injury in patients with isolated head injury.
abstract: 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.
authors: Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, United States. szehtabchi@yahoo.com
authors: Shahriar
authors: S
authors: Zehtabchi
authors: Samara
authors: S
authors: Soghoian
authors: Yiju
authors: Y
authors: Liu
authors: Kristin
authors: K
authors: Carmody
authors: Lekha
authors: L
authors: Shah
authors: Brian
authors: B
authors: Whittaker
authors: Richard
authors: R
authors: Sinert
mesh_terms: 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