gms | German Medical Science

67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

Prospective study of the incidence and impact of viscoelastometric abnormalities in isolated traumatic brain injury

Meeting Abstract

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  • Aaron Lawson McLean - Klinik für Neurochirurgie, Universitätsklinikum Jena, Germany
  • Ross Davenport - Centre for Trauma Sciences, Queen Mary University of London, United Kingdom

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMI.05.07

doi: 10.3205/16dgnc264, urn:nbn:de:0183-16dgnc2640

Veröffentlicht: 8. Juni 2016

© 2016 Lawson McLean et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

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.