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Acute Traumatic Coagulopathy Accompanying Isolated Traumatic Brain Injury is Associated with Worse Long-Term Functional and Cognitive Outcomes

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Abstract

Background

Approximately one-third of patients with isolated traumatic brain injury (iTBI) present with acute traumatic coagulopathy (ATC). ATC is associated with increased morbidity and mortality. Its effects on long-term functional and cognitive outcomes are not as well characterized.

Methods

Data from the Citicoline Brain Injury Treatment Trial (COBRIT) were analyzed retrospectively. Exclusion criteria were renal failure or malignancy, and any extracranial injury severity score >3. ATC was defined as INR > 1.3, PTT > 38 s, or platelets < 100 K, determined at baseline, and during the first 7 days of hospitalization.

Results

Six hundred forty-seven patients were included; 21 % were found to have ATC. Highest incidence occurred at baseline, and Day Two. Forty-two percent of ATC patients had a GCS < 8, compared with 11.3 % of non-ATC patients (p < 0.001). A significantly higher proportion of ATC patients was transfused blood products, required greater than 4L of fluids, demonstrated hyperthermia and hypothermia, were hypotensive and demonstrated elevated lactate when compared to non-ATC patients. In-hospital mortality, mean hospital length of stay, incidence of DVT and seizures were also significantly higher in ATC patients. A significantly lower portion of ATC patients had good outcomes on the GOS-E (i.e., score > 6), and the DRS (i.e., score < 2) at 180 days, for which ATC was found to be an independent predictor with binary logistic regression. ATC patients also performed significantly worse on several components of the CVLT-II at 180 days.

Conclusions

ATC accompanying iTBI is associated with worse functional and cognitive outcomes at 180 days.

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Authors and Affiliations

  1. Department of Neurology, Thomas Jefferson University Hospitals, 909 Walnut Street, 4th floor C.O.B building, Philadelphia, PA, 19107, USA

    Peter A. Abdelmalik, Joseph Tracy & Fred Rincon

  2. Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA

    David W. Boorman, Jack Jallo & Fred Rincon

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  1. Peter A. Abdelmalik
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  2. David W. Boorman
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Correspondence to Fred Rincon.

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Conflict of interest

Drs. Abdelmalik, Tracy and Jallo, as well as Mr. Boorman, have no sources of funding to disclose. Dr. Rincon has received salary and research grant support from the American Heart Association (AHA 12CRP12050342) and Genentech (G-29902). Data used in this study was generated by the investigators in the Clinical Sites and Data Coordinating Center composing the NIH Collaborative Multicenter TBI Clinical Trials Network. This project was funded by the National Institute of Child Health and Human Development of the National Institutes of Health. COBRIT was supported in part by National Institute Award numbers NICHD U01HD042823, U01HD042738, U01HD 042687, U01HD042736, U01HD042678, U01HD042686, U01H D042653, U01HD042689, and U01HD042652, to eight clinical sites and a data coordinating center.

Additional information

A portion of this work was presented at the 67th annual meeting of the American Academy of Neurology, April 18–25, 2015.

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Abdelmalik, P.A., Boorman, D.W., Tracy, J. et al. Acute Traumatic Coagulopathy Accompanying Isolated Traumatic Brain Injury is Associated with Worse Long-Term Functional and Cognitive Outcomes. Neurocrit Care 24, 361–370 (2016). https://doi.org/10.1007/s12028-015-0191-0

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