Acute coagulopathy in isolated blunt traumatic brain injury.
BACKGROUND
The role of acute coagulopathy after traumatic brain injury (TBI) on outcome has gained increasing appreciation over the recent years. This study was conducted to assess the frequency, outcome, and risk factors associated with this complication.


METHODS
Using the large, multi-center population-based Trauma Registry of the German Society for Trauma Surgery (TR-DGU), we retrospectively analyzed adult patients with isolated blunt TBI (intracranial AIS(HEAD) >or= 3 and extracranial AIS scores <3) for the presence of acute post-traumatic coagulopathy upon emergency room (ER) arrival. Coagulopathy was defined as prothrombin time test (Quick's value) <70% and/or platelets < 100,000/microl.


RESULTS
From a total of 3,114 eligible patients with isolated TBI, 706 (22.7%) presented with coagulopathy upon ER arrival. Coagulopathy was associated with higher rates of craniotomies (P = 0.02), of single and multiple organ failure and with less intubation-free days. In surviving patients, ICU length of stay and hospital length of stay were significantly longer, if coagulopathy had been present at admission. The overall hospital mortality was 50.4% (n = 356) in patients with coagulopathy vs. 17.3% (n = 417) in non-coagulopathic patients (all P < 0.001). Multivariate analysis identified AIS(HEAD) severity grade, GCS <or= 8 at scene, the presence of hypotension at scene and/or at ER, pre-hospital i.v.-fluids >or=2,000 ml and age >or=75 years as independent risk factors for coagulopathy after TBI. Acute coagulopathy in TBI had an adjusted odds ratio for hospital mortality of 2.97 (CI(95): 2.30-3.85; P < 0.001).


CONCLUSIONS
Coagulopathy upon ER admission is frequent after isolated blunt TBI and represents a powerful, independent predictor related to prognosis. Future research should aim to determine the beneficial effects of early treatment of TBI-associated coagulopathy.
Wafaisade
Arasch
A
Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center, Ostmerheimerstr 200, 51109 Cologne, Germany. araschw@hotmail.com
Lefering
Rolf
R
Tjardes
Thorsten
T
Wutzler
Sebastian
S
Simanski
Christian
C
Paffrath
Thomas
T
Fischer
Philipp
P
Bouillon
Bertil
B
Maegele
Marc
M
D000208:Acute Disease; D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000453:epidemiology*; D001930:Brain Injuries / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D005858:Germany / Q000453:epidemiology; D015600:Glasgow Coma Scale; D020199:Hematoma, Subdural, Acute / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000453:epidemiology* / Q000601:surgery