Rawan Abu Khater U00023097
Sarah Saeed U00022130
Coagulopathy as prognostic
marker in acute traumatic brain
Authors: Gaurav Chhabra, Subhadra Sharma, Arulselvi
Subramanian, Deepak Agrawal1, Sumit Sinha1, Asok K
Journal of Emergencies, Trauma, and Shock
Jul – Sep 2013
New Delhi, India
To assess the incidence and probable risk factors for
development of coagulopathy and to identify the risk
factors for poor outcome in terms of median survival time
Materials and Methods:
A prospective study was done over two years for patients of
isolated moderate and severe traumatic brain injury (GCS≤12)
admitted to trauma center.
The coagulation profile (PT, APTT, thrombin time, fibrinogen and
D-dimer), arterial lactate and ABG analysis was done on day of
admission and on day three.
Incidence of in-hospital mortality was assessed in all cases.
Statistical Analysis: A stepwise logistic regression analysis was
performed to identify risk factors for coagulopathy and mortality in
- 208 patients of isolated head injury
- Patients with GCS 3‐8 were categorized as Severe
Head injury (108)
- Patients with GCS 9‐12 were categorized as moderate
head injury (100)
- Males comprised 89% of the total study population
- Mean age of the study population was 32 ± 11 years
- Coagulopathy was present in 96 (46%) patients
- Severe head injury group, 66 (61%) patients out of 108
- Moderate head injury group 30 (30%) patients out of
100 developed coagulopathy
- Most common intracranial lesion in the subjects were
contusion, hemorrhage, midline shift, intracranial
fracture, effaced cisterns and diffuse axonal injury.
- Effaced cistern was found to have association with
development of coagulopathy
- Patients with coagulopathy in both the subgroups were
found to have significantly increased PT, INR, APTT
and thrombin time at the time of admission and also on
- On bivariate analysis, severity of TBI, effaced basal
cisterns on CT scan, low hemoglobin level, elevated
D‐dimer level at admission, and elevated arterial
lactate level were found to predict the development of
- Risk factors associated with poor outcome following TBI.
severity of head injury (GCS ≤ 8), presence of midline
shift, decreased platelet count at admission, presence of
coagulopathy, DIC score greater than 5, presence of
acidosis and undergoing surgery was associated with
- Patients with GCS score ≤ 8 with coagulopathy, having
DIC score ≥ 5 and who have developed acidemia
following head injury died early during the hospital stay.
The median survival time was lowest for patients who
developed acidemia and had a DIC score ≥ 5
There is a high incidence of coagulopathy following TBI.
The presences of coagulopathy as well as of severity of
TBI are strong predictors of in-hospital mortality in these