title: Coagulopathy and transfusion requirements in war related penetrating traumatic brain injury. A single centre study in a French role 3 medical treatment facility in Afghanistan.
abstract: BACKGROUND
  Traumatic brain injury associated coagulopathy is frequent, either in isolated traumatic brain injury in civilian practice and in combat traumatic brain injury. In war zone, it is a matter of concern because head and neck are the second most frequent site of wartime casualty burden. Data focusing on transfusion requirements in patients with war related TBI coagulopathy are limited.
  
  
  METHODS
  A descriptive analysis was conducted of 77 penetrating traumatic brain injuries referred to a French role 3 medical treatment facility in Kabul, Afghanistan, deployed on the Kabul International Airport (KaIA), over a 30 months period.
  
  
  RESULTS
  On 77 patients, 23 died during the prehospital phase and were not included in the study. Severe traumatic brain injury represented 50% of patients. Explosions were the most common injury mechanism. Extracranial injuries were present in 72% of patients. Traumatic brain injury coagulopathy was diagnosed in 67% of patients at role 3 admission. Red blood cell units (RBCu) were transfused in 39 (72%) patients, French lyophilized plasma (FLYP) in 41 (76%), and fresh whole blood (FWB) in 17 (31%).
  
  
  CONCLUSIONS
  The results of this study support previous observations of coagulopathy as a frequent complication of traumatic brain injury. The majority of patients with war related penetrating traumatic brain injury presented with extracranial lesions. Most of them required a high level of transfusion capacity.
authors.affiliation: Sainte Anne Military Teaching Hospital, Intensive Care Unit, Toulon, France. Electronic address: bordes.julien@neuf.fr.
authors.forename: J
authors.initials: J
authors.lastname: Bordes
authors.affiliation: Sainte Anne Military Teaching Hospital, Neurosurgery Unit, Toulon, France.
authors.forename: C
authors.initials: C
authors.lastname: Joubert
authors.affiliation: Sainte Anne Military Teaching Hospital, Intensive Care Unit, Toulon, France.
authors.forename: P
authors.initials: P
authors.lastname: Esnault
authors.affiliation: Sainte Anne Military Teaching Hospital, Intensive Care Unit, Toulon, France.
authors.forename: A
authors.initials: A
authors.lastname: Montcriol
authors.affiliation: Sainte Anne Military Teaching Hospital, Intensive Care Unit, Toulon, France.
authors.forename: C
authors.initials: C
authors.lastname: Nguyen
authors.affiliation: Sainte Anne Military Teaching Hospital, Intensive Care Unit, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Meaudre
authors.affiliation: French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France; Val-de-Grâce Military Teaching Hospital, Neurosurgery Unit, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Dulou
authors.affiliation: Sainte Anne Military Teaching Hospital, Neurosurgery Unit, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Dagain
mesh_terms: D015998:Abbreviated Injury Scale; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D001778:Blood Coagulation Disorders / Q000401:mortality / Q000628:therapy*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D000070642:Brain Injuries, Traumatic / Q000401:mortality / Q000628:therapy; D002648:Child; D005260:Female; D005602:France; D015600:Glasgow Coma Scale; D020197:Head Injuries, Penetrating / Q000401:mortality / Q000628:therapy; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D008887:Military Medicine / Q000379:methods*; D008889:Military Personnel; D012189:Retrospective Studies; D055815:Young Adult
keywords: Explosions; Field hospital; French lyophilized plasma; Gunshots; Penetrating traumatic brain injury; Transfusion; War injuries