Article week 3


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Article week 3

  1. 1. Article Presented by: Rawan Abu Khater U00023097 Sarah Saeed U00022130
  2. 2. Coagulopathy as prognostic marker in acute traumatic brain injury Authors: Gaurav Chhabra, Subhadra Sharma, Arulselvi Subramanian, Deepak Agrawal1, Sumit Sinha1, Asok K Mukhopadhyay Journal of Emergencies, Trauma, and Shock Jul – Sep 2013 New Delhi, India
  3. 3. Aim 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 following TBI
  4. 4. 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 these patients.
  5. 5. Results - 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
  6. 6. Results - Coagulopathy was present in 96 (46%) patients - Severe head injury group, 66 (61%) patients out of 108 developed coagulopathy - 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.
  7. 7. Results - 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 third day. - 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 coagulopathy
  8. 8. Results - 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 poor outcome.
  9. 9. Results - 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
  10. 10. Conclusion 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 patients.