1) The study assessed the incidence of coagulopathy in patients with moderate and severe traumatic brain injury (TBI) and identified risk factors for coagulopathy and poor outcomes. 2) Coagulopathy was present in 46% of patients and was more common in those with severe TBI (61%) than moderate TBI (30%). Risk factors for coagulopathy included effaced basal cisterns on CT scan and elevated D-dimer and lactate levels. 3) Risk factors for poor outcomes, including lower survival time, were severe TBI, midline shift, coagulopathy, high DIC score, and acidosis. Patients with coagulopathy, high DIC score, and

1. Article
Presented by:
Rawan Abu Khater U00023097
Sarah Saeed U00022130

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. 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. 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. 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. 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. 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. 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. 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. 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.