Traumatic brain injury is not associated with coagulopathy out of proportion to injury in other body regions

Tim H. Lee, David A. Hampton, Brian S. Diggs, Sean P. McCully, Matt Kutcher, Britt J. Redick, Jeannette Podbielski, Bryan A. Cotton, Mitchell Cohen, Martin Schreiber

    Research output: Contribution to journalArticle

    16 Citations (Scopus)

    Abstract

    Background: Coagulopathy following trauma is associated with poor outcomes. Traumatic brain injury 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, multicenter observational study at three Level 1 trauma centers. Conventional coagulation tests (CCTs) and rapid thrombelastography (r-TEG) were used. Admission vital signs, base deficit (BD), CCTs, and r-TEG data were collected. The Abbreviated Injury Scale (AIS) score and Injury Severity Score (ISS) were obtained. Severe injury was defined as AIS score greater than or equal to 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 score greater than or equal to 3 were excluded. Coagulation parameters were compared between the dominant AIS region. Significant hypoperfusion was defined as BD greater than or equal to 6. Results: Of the 795 patients enrolled, 462 met criteria for grouping by dominant AIS region. Patients were predominantly white (59%), were male (75%), experienced blunt trauma (71%), and had a median ISS of 25 (interquartile range, 14-29). Patients with BD greater than or equal to 6 (n = 110) were hypocoagulable by CCT and r-TEG compared with patients with BD less than 6 (n = 223). Patients grouped by dominant AIS region showed no significant differences for any r-TEG or CCT parameter. Patients with BD greater than or equal to 6 demonstrated no difference in any r-TEG or CCT parameter between dominant AIS regions. Conclusion: Coagulopathy results from a combination of tissue injury and shock independent of the dominant region of injury. With the use of AIS as a measure of injury severity, traumatic brain injury was not independently associated with more profound coagulopathy.

    Original languageEnglish (US)
    Pages (from-to)67-72
    Number of pages6
    JournalJournal of Trauma and Acute Care Surgery
    Volume77
    Issue number1
    DOIs
    StatePublished - 2014

    Fingerprint

    Abbreviated Injury Scale
    Body Regions
    Thrombelastography
    Wounds and Injuries
    Injury Severity Score
    Shock
    Traumatic Brain Injury
    Vital Signs
    Trauma Centers
    Multicenter Studies
    Observational Studies

    Keywords

    • coagulopathy
    • Trauma
    • traumatic brain injury

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Traumatic brain injury is not associated with coagulopathy out of proportion to injury in other body regions. / Lee, Tim H.; Hampton, David A.; Diggs, Brian S.; McCully, Sean P.; Kutcher, Matt; Redick, Britt J.; Podbielski, Jeannette; Cotton, Bryan A.; Cohen, Mitchell; Schreiber, Martin.

    In: Journal of Trauma and Acute Care Surgery, Vol. 77, No. 1, 2014, p. 67-72.

    Research output: Contribution to journalArticle

    Lee, TH, Hampton, DA, Diggs, BS, McCully, SP, Kutcher, M, Redick, BJ, Podbielski, J, Cotton, BA, Cohen, M & Schreiber, M 2014, 'Traumatic brain injury is not associated with coagulopathy out of proportion to injury in other body regions', Journal of Trauma and Acute Care Surgery, vol. 77, no. 1, pp. 67-72. https://doi.org/10.1097/TA.0000000000000255
    Lee, Tim H. ; Hampton, David A. ; Diggs, Brian S. ; McCully, Sean P. ; Kutcher, Matt ; Redick, Britt J. ; Podbielski, Jeannette ; Cotton, Bryan A. ; Cohen, Mitchell ; Schreiber, Martin. / Traumatic brain injury is not associated with coagulopathy out of proportion to injury in other body regions. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 77, No. 1. pp. 67-72.
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    abstract = "Background: Coagulopathy following trauma is associated with poor outcomes. Traumatic brain injury 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, multicenter observational study at three Level 1 trauma centers. Conventional coagulation tests (CCTs) and rapid thrombelastography (r-TEG) were used. Admission vital signs, base deficit (BD), CCTs, and r-TEG data were collected. The Abbreviated Injury Scale (AIS) score and Injury Severity Score (ISS) were obtained. Severe injury was defined as AIS score greater than or equal to 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 score greater than or equal to 3 were excluded. Coagulation parameters were compared between the dominant AIS region. Significant hypoperfusion was defined as BD greater than or equal to 6. Results: Of the 795 patients enrolled, 462 met criteria for grouping by dominant AIS region. Patients were predominantly white (59{\%}), were male (75{\%}), experienced blunt trauma (71{\%}), and had a median ISS of 25 (interquartile range, 14-29). Patients with BD greater than or equal to 6 (n = 110) were hypocoagulable by CCT and r-TEG compared with patients with BD less than 6 (n = 223). Patients grouped by dominant AIS region showed no significant differences for any r-TEG or CCT parameter. Patients with BD greater than or equal to 6 demonstrated no difference in any r-TEG or CCT parameter between dominant AIS regions. Conclusion: Coagulopathy results from a combination of tissue injury and shock independent of the dominant region of injury. With the use of AIS as a measure of injury severity, traumatic brain injury was not independently associated with more profound coagulopathy.",
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    T1 - Traumatic brain injury is not associated with coagulopathy out of proportion to injury in other body regions

    AU - Lee, Tim H.

    AU - Hampton, David A.

    AU - Diggs, Brian S.

    AU - McCully, Sean P.

    AU - Kutcher, Matt

    AU - Redick, Britt J.

    AU - Podbielski, Jeannette

    AU - Cotton, Bryan A.

    AU - Cohen, Mitchell

    AU - Schreiber, Martin

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    N2 - Background: Coagulopathy following trauma is associated with poor outcomes. Traumatic brain injury 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, multicenter observational study at three Level 1 trauma centers. Conventional coagulation tests (CCTs) and rapid thrombelastography (r-TEG) were used. Admission vital signs, base deficit (BD), CCTs, and r-TEG data were collected. The Abbreviated Injury Scale (AIS) score and Injury Severity Score (ISS) were obtained. Severe injury was defined as AIS score greater than or equal to 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 score greater than or equal to 3 were excluded. Coagulation parameters were compared between the dominant AIS region. Significant hypoperfusion was defined as BD greater than or equal to 6. Results: Of the 795 patients enrolled, 462 met criteria for grouping by dominant AIS region. Patients were predominantly white (59%), were male (75%), experienced blunt trauma (71%), and had a median ISS of 25 (interquartile range, 14-29). Patients with BD greater than or equal to 6 (n = 110) were hypocoagulable by CCT and r-TEG compared with patients with BD less than 6 (n = 223). Patients grouped by dominant AIS region showed no significant differences for any r-TEG or CCT parameter. Patients with BD greater than or equal to 6 demonstrated no difference in any r-TEG or CCT parameter between dominant AIS regions. Conclusion: Coagulopathy results from a combination of tissue injury and shock independent of the dominant region of injury. With the use of AIS as a measure of injury severity, traumatic brain injury was not independently associated with more profound coagulopathy.

    AB - Background: Coagulopathy following trauma is associated with poor outcomes. Traumatic brain injury 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, multicenter observational study at three Level 1 trauma centers. Conventional coagulation tests (CCTs) and rapid thrombelastography (r-TEG) were used. Admission vital signs, base deficit (BD), CCTs, and r-TEG data were collected. The Abbreviated Injury Scale (AIS) score and Injury Severity Score (ISS) were obtained. Severe injury was defined as AIS score greater than or equal to 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 score greater than or equal to 3 were excluded. Coagulation parameters were compared between the dominant AIS region. Significant hypoperfusion was defined as BD greater than or equal to 6. Results: Of the 795 patients enrolled, 462 met criteria for grouping by dominant AIS region. Patients were predominantly white (59%), were male (75%), experienced blunt trauma (71%), and had a median ISS of 25 (interquartile range, 14-29). Patients with BD greater than or equal to 6 (n = 110) were hypocoagulable by CCT and r-TEG compared with patients with BD less than 6 (n = 223). Patients grouped by dominant AIS region showed no significant differences for any r-TEG or CCT parameter. Patients with BD greater than or equal to 6 demonstrated no difference in any r-TEG or CCT parameter between dominant AIS regions. Conclusion: Coagulopathy results from a combination of tissue injury and shock independent of the dominant region of injury. With the use of AIS as a measure of injury severity, traumatic brain injury was not independently associated with more profound coagulopathy.

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