title: Acute Traumatic Coagulopathy Accompanying Isolated Traumatic Brain Injury is Associated with Worse Long-Term Functional and Cognitive Outcomes.
abstract: Approximately one-third of patients with isolated traumatic brain injury (iTBI) present with acute traumatic coagulopathy (ATC). ATC is associated with increased morbidity and mortality. Its effects on long-term functional and cognitive outcomes are not as well characterized.
  
  
  
  Data from the Citicoline Brain Injury Treatment Trial (COBRIT) were analyzed retrospectively. Exclusion criteria were renal failure or malignancy, and any extracranial injury severity score >3. ATC was defined as INR > 1.3, PTT > 38 s, or platelets < 100 K, determined at baseline, and during the first 7 days of hospitalization.
  
  
  
  Six hundred forty-seven patients were included; 21 % were found to have ATC. Highest incidence occurred at baseline, and Day Two. Forty-two percent of ATC patients had a GCS < 8, compared with 11.3 % of non-ATC patients (p < 0.001). A significantly higher proportion of ATC patients was transfused blood products, required greater than 4L of fluids, demonstrated hyperthermia and hypothermia, were hypotensive and demonstrated elevated lactate when compared to non-ATC patients. In-hospital mortality, mean hospital length of stay, incidence of DVT and seizures were also significantly higher in ATC patients. A significantly lower portion of ATC patients had good outcomes on the GOS-E (i.e., score > 6), and the DRS (i.e., score < 2) at 180 days, for which ATC was found to be an independent predictor with binary logistic regression. ATC patients also performed significantly worse on several components of the CVLT-II at 180 days.
  
  
  
  ATC accompanying iTBI is associated with worse functional and cognitive outcomes at 180 days.
authors: Department of Neurology, Thomas Jefferson University Hospitals, 909 Walnut Street, 4th floor C.O.B building, Philadelphia, PA, 19107, USA.
authors: Peter A
authors: PA
authors: Abdelmalik
authors: Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
authors: David W
authors: DW
authors: Boorman
authors: Department of Neurology, Thomas Jefferson University Hospitals, 909 Walnut Street, 4th floor C.O.B building, Philadelphia, PA, 19107, USA.
authors: Joseph
authors: J
authors: Tracy
authors: Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
authors: Jack
authors: J
authors: Jallo
authors: Department of Neurology, Thomas Jefferson University Hospitals, 909 Walnut Street, 4th floor C.O.B building, Philadelphia, PA, 19107, USA. fred.rincon@jefferson.edu.|Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA. fred.rincon@jefferson.edu.
authors: Fred
authors: F
authors: Rincon
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D003566:Cytidine Diphosphate Choline / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018697:Nootropic Agents / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018697:Nootropic Agents; D003566:Cytidine Diphosphate Choline
keywords: Coagulation; Head injury; Neuropsychology; Trauma