Artikel
Prospective study of the incidence and impact of viscoelastometric abnormalities in isolated traumatic brain injury
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Autoren
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Aaron Lawson McLean
- Klinik für Neurochirurgie, Universitätsklinikum Jena, Germany
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Ross Davenport
- Centre for Trauma Sciences, Queen Mary University of London, United Kingdom
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: The incidence of coagulation dysfunction is high in patients with traumatic brain injury (TBI) and TBI-associated coagulopathy correlates with poor clinical outcomes. This prospective study was designed to assess the potential role of whole-blood thromboelastometry in TBI, utilising the ROTEM measurement platform and a high-quality prospective dataset from a UK major trauma centre. We hypothesised that coagulopathy is predictive of outcome in isolated TBI patients and that it can be identified with both standard laboratory coagulation tests and point-of-care tests.
Method: Patients were prospectively enrolled in an observational cohort study at a UK major trauma centre between 2009 and 2014. The subset of patients with isolated, severe TBI were defined adult patient (>16) with AIS[head] ≥3 and AIS[extracranial] <3. ROTEM profiles and standard coagulation parameters were obtained on admission, alongside demographic and clinical variables (including 28-day survival). Coagulopathy was defined in accordance with previous literature, based on perturbations in standard laboratory and ROTEM values.
Results: Out of 109 consecutive patients with isolated, severe TBI enrolled in the study, 87 survived (79.8%) and 22 died (20.2%). The median number of days until death among non-surviving patients was 6 (IQR 2-21). There were 76 males and 33 females. The median age of subjects was 40 years. The cohort encompassed 105 cases of blunt trauma and 4 cases of penetrating trauma. The median injury severity score (ISS) was 17 (IQR 6-25). Fibrinogen and platelet count were significantly higher in survivors (p< 0.005) than non-survivors. Accordingly, both APTT and INR were significantly lower in this group (p<0.005). The same pattern of abnormalities in the intrinsic and extrinsic clotting cascades was also present on ROTEM analysis.
Conclusions: Thromboelastometric findings were significantly different between survivors and non-survivors, with longer clotting times and lower maximum firmness of clots in non-survivors. This study suggests that ROTEM® may add important information for identifying TBI patients at increased risk of poor outcome. This has implications for the early management of TBI and for prognostication.
