Artikel
Hemorrhagic progression of brain contusions as a risk factor for poor outcome in patients with major multiple traumas including traumatic brain injuries
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Autoren
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Tareq A. Juratli
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinik Carl Gustav Carus Dresden der Technischen Universität Dresden
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Natalie Mai
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinik Carl Gustav Carus Dresden der Technischen Universität Dresden
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Hakan Sitoci
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinik Carl Gustav Carus Dresden der Technischen Universität Dresden
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Gabriele Schackert
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinik Carl Gustav Carus Dresden der Technischen Universität Dresden
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Stephan B. Sobottka
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinik Carl Gustav Carus Dresden der Technischen Universität Dresden
| Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: To quantify the rate of secondary coagulopathy based on abnormal values in routine blood tests, and its influence on the neurological outcome of patients with multiple major traumas including traumatic brain injuries (TBI). A further objective is to determine the risk factors for hemorrhagic progression of brain contusions (HPC) in this patients' study group.
Method: A prospective evaluation was completed at one institution of TBI patients with major extra-cranial injuries between January 2008 and October 2012. The data of 84 patients were analyzed. The collected data included: demographics, initial GCS, pupillary response, initial and follow-up CT scans, coagulation parameters (INR, PTT, platelet count, fibrinogen, D-Dimer and factor XIII), injury severity score (ISS), as well as outcome data using the modified Rankin score (mRS) at discharge and one year later.
Results: The incidence of secondary coagulopathy was 72.6%. Patients with HPC (38.5%) had a significantly higher rate of unfavorable outcome at discharge (p=0.021) and after one year (p=0.026). Overall, HPC was significantly associated with an initial coagulation disorder within 3 hours after trauma. Risk factors for a poor neurological outcome (mRS≥4) at discharge were a low initial GCS, a pathological pupillary response, a high ISS as well as a low platelet count. When analyzing for risk factors which independently influence outcome in the form of mRS≥4 one year after follow-up, the following variables appeared: a low initial GCS, a pathological pupillary response, a high ISS, a pathological INR<1.2, and a fibrinogen level <2 g/l, D-Dimer ≥10.000µg/L.
Conclusions: Unfavorable neurological outcome and HPC after major multiple traumas with TBI is determined largely by the secondary coagulopathy, which seemed to occur very frequently in this patients’ collective, irrespective of the severity of the trauma. In our study, coagulation parameters, such as platelet count, D-Dimers, INR, factor XIII, and fibrinogen, are directly associated with the outcome in TBI patients with extra-cranial injuries.
