title: Thrombelastography-identified coagulopathy is associated with increased morbidity and mortality after traumatic brain injury.
abstract: BACKGROUND
  The purpose of this study was to determine the relationship between coagulopathy and outcome after traumatic brain injury.
  
  
  METHODS
  Patients admitted with a traumatic brain injury were enrolled prospectively and admission blood samples were obtained for kaolin-activated thrombelastogram and standard coagulation assays. Demographic and clinical data were obtained for analysis.
  
  
  RESULTS
  Sixty-nine patients were included in the analysis. A total of 8.7% of subjects showed hypocoagulability based on a prolonged time to clot formation (R time, > 9 min). The mortality rate was significantly higher in subjects with a prolonged R time at admission (50.0% vs 11.7%). Patients with a prolonged R time also had significantly fewer intensive care unit-free days (8 vs 27 d), hospital-free days (5 vs 24 d), and increased incidence of neurosurgical intervention (83.3% vs 34.9%).
  
  
  CONCLUSIONS
  Hypocoagulability as shown by thrombelastography after traumatic brain injury is associated with worse outcomes and an increased incidence of neurosurgical intervention.
authors.affiliation: Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code L-223, Portland, OR 97239-3098, USA. Electronic address: kunion@ohsu.edu.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Kunio
authors.affiliation: Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code L-223, Portland, OR 97239-3098, USA.
authors.forename: Jerome A
authors.initials: JA
authors.lastname: Differding
authors.affiliation: Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code L-223, Portland, OR 97239-3098, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Watson
authors.affiliation: Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code L-223, Portland, OR 97239-3098, USA.
authors.forename: Ryland S
authors.initials: RS
authors.lastname: Stucke
authors.affiliation: Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code L-223, Portland, OR 97239-3098, USA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000209:etiology*; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013916:Thrombelastography