Prevalence and Clinical Implications of Coagulopathy in Patients with Isolated Head Trauma
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- Category: Vol. 79, September 2011
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Prevalence and Clinical Implications of Coagulopathy in Patients with Isolated Head Trauma MOHAMED SHEHATA, M.D.; MOHAMED IBRAHIM AFIFY, M.D.; MOHAMED EL-SHAFIE, M.D. and MOHAMED KHALED, M.D.
Abstract
Background: Many studies showed conflicting data about use of many scoring systems to predict the mortality following head trauma. Coagulopathy is a recent concern in patients with traumatic brain injury (TBI), it is related to extent of brain tissue trauma, this will activate the extrinsic pathway of coagulation, and cause a state of consumptive coagulopathy which in turn activate a cascade of multiple organ dysfunction & increased risk of mortality.
Aim of the Work: To detect the prevalence of coagulopathy among patients with isolated TBI and the predictive value of TBI-related coagulopathy with outcome.
Patients and Methods: 101 patients with TBI were enrolled in our prospective study along one year duration, admitted to neurological intensive care unit (NICU), in whom we followed Glasgow Coma scale (GCS), Acute Physiology Age and Chronic Health Evaluation (APACHE II) score, coagulopathy markers including high INR, D-dimer, low platelets count & prolonged PT. Functional status outcome included; improved, vegetative state and mortality, and characteristics of coagulo-pathic versus non coagulopathic patients were also monitored.
Results: Overall mortality in the study was 45%, 26% discharged with vegetative state to step down unit, and 29% survived the ICU course. Coagulopathy was present in 63% of all patients (D-dimer was positive in 32%, prolonged PT more than 13 seconds in 46%, high INR more than 1.2 in 46% of all patients and thrombocytopenia was present in 4.9% of all patients), patients with coagulopathy showed older age 41±17 versus 31±15 years, (p<0.003), higher APACHE II score 16 versus 13 (p<0.005), lower GCS 5±2 versus 8±3 (p<0.000), shorter average length of stay (ALOS) 11±4 versus 13±4 day (p<0.008), and higher mortality 36% versus 10% (p<0.003).
Conclusion: Coagulopathy is common in patients with severe TBI and associated with low GCS, high APAHCE II score and it is one of independent risk factor for mortality in such group of patients.