title: Normalization of coagulopathy is associated with improved outcome after isolated traumatic brain injury.
abstract: Acute traumatic coagulopathy (ATC) has been reported in the setting of isolated traumatic brain injury (iTBI) and is associated with poor outcomes. We aimed to evaluate the effectiveness of procoagulant agents administered to patients with ATC and iTBI during resuscitation, hypothesizing that timely normalization of coagulopathy may be associated with a decrease in mortality. A retrospective review of the Alfred Hospital trauma registry, Australia, was conducted and patients with iTBI (head Abbreviated Injury Score [AIS] ⩾3 and all other body AIS <3) and coagulopathy (international normalized ratio ⩾1.3) were selected for analysis. Data on procoagulant agents used (fresh frozen plasma, platelets, cryoprecipitate, prothrombin complex concentrates, tranexamic acid, vitamin K) were extracted. Among patients who had achieved normalization of INR or survived beyond 24hours and were not taking oral anticoagulants, the association of normalization of INR and death at hospital discharge was analyzed using multivariable logistic regression analysis. There were 157 patients with ATC of whom 68 (43.3%) received procoagulant products within 24hours of presentation. The median time to delivery of first products was 182.5 (interquartile range [IQR] 115-375) minutes, and following administration of coagulants, time to normalization of INR was 605 (IQR 274-1146) minutes. Normalization of INR was independently associated with significantly lower mortality (adjusted odds ratio 0.10; 95% confidence interval 0.03-0.38). Normalization of INR was associated with improved mortality in patients with ATC in the setting of iTBI. As there was a substantial time lag between delivery of products and eventual normalization of coagulation, specific management of coagulopathy should be implemented as early as possible.
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Epstein
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; National Trauma Research Institute, Melbourne, VIC, Australia. Electronic address: biswadev.mitra@monash.edu.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.affiliation: National Trauma Research Institute, Melbourne, VIC, Australia; Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
authors.affiliation: Department of Surgery, Monash University, Melbourne, VIC, Australia; Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of The Health Sciences (USUHS), Bethesda, MD, USA.
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Rosenfeld
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000401:mortality / Q000628:therapy; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010949:Plasma; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001779:Blood Coagulation Factors
keywords: Blood coagulation; Coagulopathy; Craniocerebral trauma; Injuries; Isolated head trauma; Traumatic brain injury