title: Adenosine diphosphate platelet dysfunction on thromboelastogram is independently associated with increased morality in traumatic brain injury.
abstract: OBJECTIVE
  The purpose of this study is to determine if adenosine diphosphate (ADP) platelet dysfunction on thromboelastogram (TEG) is associated with increased in-hospital mortality in patients with head trauma. The hypothesis is that ADP dysfunction is associated with increased mortality.
  
  
  METHODS
  This retrospective review evaluated trauma patients admitted to a level 1 trauma center from February 2011 to October 2013 who received a TEG. Patients were included if the TEG was drawn within the first 24 h of admission and the head abbreviated injury score was greater than or equal to three. Patients were categorized as severe ADP dysfunction if the degree of ADP inhibition on TEG exceeded 60 %.
  
  
  RESULTS
  A total of 90 patients were included (no ADP dysfunction n = 37; ADP dysfunction n = 53). Initial Glasgow Coma Scale [GCS (12 ± 4 vs. 11 ± 5; p = 0.26)] and use of pre-injury antiplatelet agents (30 vs. 28 %; p = 0.88) were similar. Patients with ADP dysfunction on TEG had a higher in-hospital mortality rate (8 vs. 32 %; p < 0.01). ADP dysfunction was independently associated with in-hospital mortality upon fixed logistic regression (OR 6.2; 95 % CI 1.2-33) while controlling for age, gender, hypotension, pre-injury antiplatelet agents, GCS and Injury Severity Score.
  
  
  CONCLUSIONS
  ADP dysfunction on TEG is associated with increased mortality in patients with traumatic brain injury.
authors.affiliation: Department of Pharmaceutical Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA. mjdaley@seton.org.|College of Pharmacy, University of Texas, Austin, TX, USA. mjdaley@seton.org.
authors.forename: M J
authors.initials: MJ
authors.lastname: Daley
authors.affiliation: Department of Pharmaceutical Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA.|College of Pharmacy, University of Texas, Austin, TX, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Enright
authors.affiliation: Department of Pharmaceutical Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA.|College of Pharmacy, University of Texas, Austin, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Nguyen
authors.affiliation: Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ali
authors.affiliation: Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA.
authors.forename: A
authors.initials: A
authors.lastname: Clark
authors.affiliation: Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA.|Dell Medical School, University of Texas, Austin, TX, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Aydelotte
authors.affiliation: Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA.|Dell Medical School, University of Texas, Austin, TX, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: Teixeira
authors.affiliation: Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA.|Dell Medical School, University of Texas, Austin, TX, USA.
authors.forename: T B
authors.initials: TB
authors.lastname: Coopwood
authors.affiliation: Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA.|Dell Medical School, University of Texas, Austin, TX, USA.
authors.forename: C V R
authors.initials: CV
authors.lastname: Brown
mesh_terms: D000244:Adenosine Diphosphate / Q000097:blood*; D000368:Aged; D001792:Blood Platelets / Q000502:physiology*; D000070642:Brain Injuries, Traumatic / Q000097:blood* / Q000401:mortality*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010979:Platelet Function Tests; D012189:Retrospective Studies; D013916:Thrombelastography
chemical_list: D000244:Adenosine Diphosphate
keywords: Platelet dysfunction; TEG; Thromboelastogram; Traumatic brain injury