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Traumatic Brain Injury Associated Coagulopathy

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Abstract

Background

The presence of coagulopathy is common after severe trauma. The aim of this study was to identify whether isolated severe traumatic brain injury (TBI) is an independent risk factor for coagulopathy.

Methods

Prospective observational cohort of adult patients admitted to a Level I Trauma Center within 6 h of injury. Patients were categorized according to the abbreviated injury scale (AIS): Group 1-isolated severe TBI (AIS head ≥ 3 + AIS non-head < 3); Group 2-severe multisystem trauma associated with severe TBI (AIS head ≥ 3 + AIS non-head ≥ 3); Group 3-severe multisystem trauma without TBI (AIS head < 3 + AIS non-head ≥ 3). Primary outcome was the development of coagulopathy. Secondary outcome was in-hospital mortality.

Results

Three hundred and forty five patients were included (Group 1 = 48 patients, Group 2 = 137, and Group 3 = 160). Group 1 patients had the lowest incidence of coagulopathy and disseminated intravascular coagulopathy, and in general presented with better coagulation profile measured by either classic coagulation tests, thromboelastography or clotting factors. Isolated severe TBI was not an independent risk factor for the development of coagulopathy (OR 1.06; 0.35–3.22 CI, p = 0.92), however, isolated severe TBI patients who developed coagulopathy had higher mortality rates than isolated severe TBI patients without coagulopathy (66 vs. 16.6 %, p < 0.05). The presence of coagulopathy (OR 5.61; 2.65–11.86 CI, p < 0.0001) and isolated severe TBI (OR 11.51; 3.9–34.2 CI, p < 0.0001) were independent risk factors for in-hospital mortality.

Conclusion

Isolated severe TBI is not an independent risk factor for the development of coagulopathy. However, severe TBI patients who develop coagulopathy have extremely high mortality rates.

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Acknowledgments

S·B.R. received a salary award from the Canadian Institute of Health Research/NovoNordisk, honoraria and speaking fees from NovoNordisk.

Conflict of interest

None of the authors have conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Trauma & Neurosurgical Intensive Care Unit, St. Michael’s Hospital-University of Toronto, 30 Bond Street Donnelly Wing, Room 3-074B, Toronto, ON, M4N 3M5, Canada

    Airton Leonardo de Oliveira Manoel & Sandro Rizoli

  2. Department of Medical Imaging, Interventional Neuroradiology, St. Michael’s Hospital-University of Toronto, Toronto, ON, Canada

    Airton Leonardo de Oliveira Manoel

  3. St. Michael’s Hospital-University of Toronto Endowed Chair in Trauma Research, Toronto, Canada

    Sandro Rizoli

  4. Adult Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil

    Antonio Capone Neto

  5. Sunnybrook Health Sciences Centre, Toronto, Canada

    Precilla V. Veigas

Authors
  1. Airton Leonardo de Oliveira Manoel
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  2. Antonio Capone Neto
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  3. Precilla V. Veigas
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  4. Sandro Rizoli
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Corresponding author

Correspondence to Airton Leonardo de Oliveira Manoel.

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de Oliveira Manoel, A.L., Neto, A.C., Veigas, P.V. et al. Traumatic Brain Injury Associated Coagulopathy. Neurocrit Care 22, 34–44 (2015). https://doi.org/10.1007/s12028-014-0026-4

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  • DOI: https://doi.org/10.1007/s12028-014-0026-4

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