Sherry L Sixta, Jessica C Cardenas, Ryan Kitagawa, Charles E Wade, John B Holcomb and Bryan A Cotton
Background: Conflicting data exist regarding the association of traumatic brain injury (TBI) with coagulopathy as measured by conventional coagulation testing (CCT).
Objective: This study is intended to determine the prevalence of coagulopathy in TBI patients by CCT and rapid thrombelastography (r-TEG) and to determine the relationship between these laboratory tests and mortality.
Methods: Over an 18-month period, the admission r-TEG values (ACT, R-value, k-time, alpha, mA, and LY30) and CCTs (aPTT, INR, platelet count, and fibrinogen) were recorded on the highest-level trauma activations admitted directly from the injury scene. Patients were then categorized as non-TBI (Head AIS 0-2) or isolated TBI (Head AIS >2 and all other AIS scores ≤ 2), and all other patients were excluded. A patient has determined to have a coagulopathy if one or more of the following was present: aPTT>35 sec, INR>1.5, platelet count<150, fibrinogen <180, ACT>128, R>1.1, k>2.5, alpha<56, mA<55, LY30>3%.
Results: 1847 non-TBI patients and 77 isolated-TBI were identified. No significant difference was detected between the groups by CCT, but the isolated-TBI group was found to have more patients with mA<55 by r-TEG (p=0.034). Multiple logistic regression revealed mA<55 (OR 3.68; p=0.015) or alpha<56 (OR 22.23; p<0.001) were predictive of 24-hour mortality in all patients. However, in isolated TBI patients, the presence of either of these hypocoagulable variables was uniformly fatal.
Conclusion: No difference in coagulopathy prevalence was observed between TBI and non-TBI patients by CCT, but a higher prevalence of coagulopathy by r-TEG values was found in isolated TBI patients and was predictive of mortality.