gms | German Medical Science

Introduction: To quantify the rate and risk factors for hemorrhagic progression of brain contusions (HPC) in patients with traumatic brain injuries (TBI) and to evaluate their impact on patients’ outcome. Further, based on abnormal values in routine blood tests, the role of secondary coagulopathy is analyzed in detail.

Material and methods: An evaluation of the TBI databank of one institution with direct data collection upon admission of TBI patients between January 2008 and December 2012. Out of 335 TBI patients, the data of 153 patients with a TBI who did not have major extracranial injuries were analyzed. The collected data included: demographics, initial GCS, pupillary response, initial and follow-up CT scans, coagulation parameters (INR, PTT, platelet count, fibrinogen, D-Dimer and factor XIII) as well as outcome data using the modified Rankin score (mRS) at discharge and one year later.

Results: The overall rate of HPC amounted to 43.5%. The frequency of coagulopathy was 61.4%. When analyzing for risk factors which independently influence outcome in the form of mRS≥4 at both points, the following variables appeared: elevated D-Dimer level (≥10.000 µg/L), HPC and initial brain contusions ≥3 cm. Patients with D-Dimer ≥10.000 µg/L had a significantly increased risk of poor outcome with a hazard ratio (HR) of 4.5 (p=0.024) for mRS≥4 at discharge and a HR of 6.6 (p=0.010) for mRS≥4 after one year. Patients sustaining HPC had a HR of 4.8 for unfavorable outcome at discharge (p=0.002) and of 2.9 after one year (p=0.026). Overall, patients developing HPC were significantly more likely to be gravely disabled or to die.

Conclusion: Unfavorable neurological outcome after an isolated TBI is determined largely by HPC and coagulopathy which seem to occur very frequently in TBI patients, irrespective of the severity of the trauma. Coagulation parameters, such as D-Dimers, platelet count and fibrinogen are directly associated with the short- and long-term outcome in TBI patients.