Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome
Introduction Traumatic brain injury (TBI) affects the coagulation pathway in a distinct way than does extracranial trauma. The extent of coagulation abnormalities varies from bleeding diathesis to disseminated thrombosis. Design Prospective study. Methods The study included 50...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2022-12-01
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| Series: | Indian Journal of Neurosurgery |
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| author | Gopal Krishna Varun Aggarwal Ishwar Singh |
| author_facet | Gopal Krishna Varun Aggarwal Ishwar Singh |
| author_sort | Gopal Krishna |
| collection | DOAJ |
| description | Introduction Traumatic brain injury (TBI) affects the coagulation pathway in a distinct way than does extracranial trauma. The extent of coagulation abnormalities varies from bleeding diathesis to disseminated thrombosis.
Design Prospective study.
Methods The study included 50 patients of isolated TBI with cohorts of moderate (MHI) and severe head injury (SHI). Coagulopathy was graded according to the values of parameters in single laboratory. The incidence of coagulopathy according to the severity of TBI and correlation with disseminated intravascular coagulation (DIC) score, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen was observed. The comparison was also made between expired and discharged patients within each group. It also compared coagulation derailments with clinical presentation (Glasgow Coma Scale [GCS]) and outcome (Glasgow Outcome Scale [GOS]).
Results Road traffic accident was the primary (72%) mode of injury. Fifty-two percent had MHI and rest had SHI. Eighty-four percent of cases were managed conservatively. The mean GCS was 12.23 and 5.75 in MHI and SHI, respectively. Sixty-two percent of MHI and 96% of the patients with SHI had coagulation abnormalities. On statistical analysis, DIC score (p < 0.001) strongly correlated with the severity of head injury and GOS. PT and APTT were also significantly associated with the severity of TBI. In patients with moderate TBI, D-dimer and platelet counts showed association with clinical outcome. Fibrinogen levels did not show any statistical significance. The mean platelet counts remained normal in both the groups of TBI. The mean GOS was 1.54 and 4.62 in SHI and MHI, respectively.
Conclusion Coagulopathy is common in isolated TBI. The basic laboratory parameters are reliable predictors of coagulation abnormalities in TBI. Coagulopathy is directly associated with the severity of TBI, GCS, and poor outcome. |
| format | Article |
| id | doaj-art-0a55fe44f81f4cdea08e6e296db42842 |
| institution | OA Journals |
| issn | 2277-954X 2277-9167 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
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| series | Indian Journal of Neurosurgery |
| spelling | doaj-art-0a55fe44f81f4cdea08e6e296db428422025-08-20T01:58:55ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Neurosurgery2277-954X2277-91672022-12-01110325325910.1055/s-0041-1728989Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical OutcomeGopal Krishna0Varun Aggarwal1Ishwar Singh2Department of Neurosurgery, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, IndiaDepartment of Neurosurgery, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, IndiaDepartment of Neurosurgery, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, IndiaIntroduction Traumatic brain injury (TBI) affects the coagulation pathway in a distinct way than does extracranial trauma. The extent of coagulation abnormalities varies from bleeding diathesis to disseminated thrombosis. Design Prospective study. Methods The study included 50 patients of isolated TBI with cohorts of moderate (MHI) and severe head injury (SHI). Coagulopathy was graded according to the values of parameters in single laboratory. The incidence of coagulopathy according to the severity of TBI and correlation with disseminated intravascular coagulation (DIC) score, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen was observed. The comparison was also made between expired and discharged patients within each group. It also compared coagulation derailments with clinical presentation (Glasgow Coma Scale [GCS]) and outcome (Glasgow Outcome Scale [GOS]). Results Road traffic accident was the primary (72%) mode of injury. Fifty-two percent had MHI and rest had SHI. Eighty-four percent of cases were managed conservatively. The mean GCS was 12.23 and 5.75 in MHI and SHI, respectively. Sixty-two percent of MHI and 96% of the patients with SHI had coagulation abnormalities. On statistical analysis, DIC score (p < 0.001) strongly correlated with the severity of head injury and GOS. PT and APTT were also significantly associated with the severity of TBI. In patients with moderate TBI, D-dimer and platelet counts showed association with clinical outcome. Fibrinogen levels did not show any statistical significance. The mean platelet counts remained normal in both the groups of TBI. The mean GOS was 1.54 and 4.62 in SHI and MHI, respectively. Conclusion Coagulopathy is common in isolated TBI. The basic laboratory parameters are reliable predictors of coagulation abnormalities in TBI. Coagulopathy is directly associated with the severity of TBI, GCS, and poor outcome.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1728989coagulopathytbidic scorehead injury |
| spellingShingle | Gopal Krishna Varun Aggarwal Ishwar Singh Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome Indian Journal of Neurosurgery coagulopathy tbi dic score head injury |
| title | Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome |
| title_full | Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome |
| title_fullStr | Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome |
| title_full_unstemmed | Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome |
| title_short | Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome |
| title_sort | prospective analysis of coagulopathy associated with isolated traumatic brain injury and clinical outcome |
| topic | coagulopathy tbi dic score head injury |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1728989 |
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