Highlights from #EAST2014 - Coagulopathy after Traumatic Brain Injury

TRAUMATIC BRAIN INJURY IS NOT ASSOCIATED WITH COAGULOPATHY OUT OF PROPORTION TO INJURY IN OTHER BODY REGIONS

Tim H. Lee, MD, MS, David A. Hampton, MD, MEng, Brian S. Diggs, PhD,

Sean P. McCully, MD, MS, Matthew Kutcher, MD, Brittney J. Redick, BA, Jeanette M. Podbielski, RN BSN, Tim Welch, NREMT-FP-C, Bryan A. Cotton, MD, MPH*, Mitchell J. Cohen, MD, FACS, Martin A. Schreiber, MD, FACS*
Oregon Health and Science University

Presenter: Tim H. Lee, MD MS
Discussant: Tanya Zakrison, MD, FRCSC, Miller School of Medicine

Objectives: Coagulopathy following trauma is associated with poor outcomes. Traumatic brain injury (TBI) has been associated with coagulopathy out of proportion to other body regions. We hypothesized that injury severity and shock determine coagulopathy independent of body region injured.

Methods: We performed a prospective, multi-center observational study at three level 1 trauma
centers. Conventional coagulation tests (CCT) and rapid thrombelastography (rTEG) were used. Admission vital signs, base deficit (BD), CCTs, and rTEG data were collected. The abbreviated injury score (AIS) and injury severity score (ISS) were obtained. Severe injury was defined as AIS≥3 for each body region. Patients were grouped according to their dominant AIS region of injury. Dominant region of injury was defined as the single region with the highest AIS score. Patients with two or more regions with the same greatest AIS score and patients without a region with an AIS≥3 were excluded. Coagulation parameters were compared between the dominant AIS region. Significant hypoperfusion was defined as BD≥6.

Results: Of the 795 patients enrolled, 405 had complete admission data and met criteria for grouping by dominant AIS region. Patients were predominantly Caucasian (59%), male (75%), suffered blunt trauma (71%), and had a median ISS of 25 (IQR 14, 29). Patients with BD≥6 (n=110) were hypocoagulable by CCT and rTEG compared to patients with BD<6 (n=223). Patients grouped by dominant AIS region showed no significant differences between any rTEG or CCT parameter. Patients with BD≥6 demonstrated no difference in any rTEG or CCT parameter between dominant AIS regions.

Conclusions: Coagulopathy results from a combination of tissue injury and shock independent of the dominant region of injury. Utilizing AIS as a measure of injury severity, TBI was not independently associated with more profound coagulopathy.