title: Predictors of deterioration indicating a requirement for surgery in mild to moderate traumatic brain injury.
abstract: OBJECTIVE
  Careful course observation is necessary for cases of mild to moderate traumatic brain injury even when disturbed consciousness is mild on admission. This is because delayed enlargement of hematoma and progression of cerebral swelling may occur and result in an emergency craniotomy. Here, we investigated coagulopathy and abnormal fibrinolysis as a predictive factor of "deterioration requiring surgery" in mild to moderate traumatic brain injury.
  
  
  METHODS
  Sixty-one patients with mild to moderate (Glasgow Coma Scale (GCS) score 9-15) traumatic brain injury were admitted between June 2009 and October 2010. There were 54 subjects in the study, excluding those treated with oral antiplatelet agents and anticoagulants. Patients were classified into those with deterioration requiring surgery [op(+)] or those without deterioration requiring surgery [op(-)]. This was based on whether surgical treatment was performed for hematoma expansion, and exacerbated consciousness level within 3 days after admission. Age, GCS score on admission and blood test findings (platelet count, PT-INR, APTT, fibrinogen, FDP, and d-dimer) on admission were compared.
  
  
  RESULTS
  The op(+) and op(-) groups comprised 7 (13.0%) and 47 patients (87.0%), respectively. Platelet counts (24.8 vs 18.5 × 10(4)/μl) were decreased, and PT-INR (1.0 vs 1.2) was higher in the op(+) group. Specially, APTT (28.6 vs 39.1s), FDP (28.9 vs 112.9 μg/ml), and D-dimer (17.3 vs 69.6 μg/ml) values were significantly higher in the op(+) group.
  
  
  CONCLUSIONS
  Coagulopathy and abnormal fibrinolysis, which are measurable in routine medical practice, is associated with deterioration requiring surgery in mild to moderate traumatic brain injury, indicating that careful course observation is necessary.
authors.affiliation: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan. Electronic address: suehiro-nsu@umin.ac.jp.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Suehiro
authors.affiliation: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Koizumi
authors.affiliation: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Fujiyama
authors.affiliation: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoneda
authors.affiliation: Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
authors.forename: Michiyasu
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000209:etiology / Q000473:pathology; D001930:Brain Injuries / Q000601:surgery*; D015331:Cohort Studies; D003399:Craniotomy; D018450:Disease Progression; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D015600:Glasgow Coma Scale; D006801:Humans; D019934:International Normalized Ratio; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Coagulopathy; Exacerbation; Mild traumatic brain injury; Moderate traumatic brain injury; Talk and deteriorate