TY  - JOUR
PY  - 2020//
TI  - Coagulopathy as a surrogate of severity of injury in penetrating brain injury
JO  - Journal of neurotrauma
A1  - Mansour, Ali
A1  - Loggini, Andrea
A1  - Goldenberg, Fernando
A1  - Kramer, Christopher
A1  - Naidech, Andrew
A1  - El Ammar, Faten
A1  - Vasenina, Valentina
A1  - Castro, Brandyn
A1  - Das, Paramita
A1  - Horowitz, Peleg
A1  - Karrison, Theodore
A1  - Zakrison, Tanya
A1  - Hampton, David
A1  - Rogers, Selwyn O.
A1  - Lazaridis, Christos
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - Penetrating brain injury (PBI) is the most devastating type of traumatic brain injury. Development of coagulopathy in the acute setting of PBI while common, remains of unclear significance as does its reversal. The aim of this study is to investigate the relationship between coagulopathy and clinical presentation, radiographic features, and outcome in civilian patients with PBI. Eighty-nine adult patients with PBI at a level I trauma center in Chicago who survived acute resuscitation and with available coagulation profile were analyzed. Coagulopathy was defined as INR > 1.3, platelet count < 100,000 /μL, or PTT > 37 seconds. Median age (IQR) of our cohort was 27 (21-35) years, and 74 (83%) were male. The intent was assault in 74 cases (83%). The mechanism of PBI was gunshot wound in in all patients. Forty patients (45%) were coagulopathic at presentation. In a multiple regression model, coagulopathy was associated with lower Glasgow Coma Scale-motor score (GCS-M) (OR:0.67, CI: 0.48-0.94, p=0.02) and transfusion of blood products (OR: 3.91, CI:1.2-12.5, p=0.02). Effacement of basal cisterns was the only significant radiographic features associated with coagulopathy (OR:3.34, IC 1.08-10.37, p=0.04). Mortality was found to be significantly more common in coagulopathic patients (73% vs. 25%, p<0.001). However, in our limited sample, reversal of coagulopathy at 24 hours was not associated with a statistically significant improvement in outcome. The triad of coagulopathy, low post-resuscitation GCS, and radiographic effacement of basal cisterns, identifies a particularly ominous phenotype of PBI. The role, and potential reversal of, coagulopathy in this group warrants further investigation.<p />  <p>Language: en</p>
LA  - en
SN  - 0897-7151
UR  - http://dx.doi.org/10.1089/neu.2020.7422
ID  - ref1
ER  -