• Arasch Wafaisade, Rolf Lefering, Thorsten Tjardes, Sebastian Wutzler, Christian Simanski, Thomas Paffrath, Philipp Fischer, Bertil Bouillon, Marc Maegele, and Trauma Registry of DGU.
• Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center, Ostmerheimerstr 200, 51109 Cologne, Germany. araschw@hotmail.com
• Neurocrit Care. 2010 Apr 1;12(2):211-9.

BackgroundThe role of acute coagulopathy after traumatic brain injury (TBI) on outcome has gained increasing appreciation over the recent years. This study was conducted to assess the frequency, outcome, and risk factors associated with this complication.Patients And MethodsUsing the large, multi-center population-based Trauma Registry of the German Society for Trauma Surgery (TR-DGU), we retrospectively analyzed adult patients with isolated blunt TBI (intracranial AIS(HEAD) >or= 3 and extracranial AIS scores <3) for the presence of acute post-traumatic coagulopathy upon emergency room (ER) arrival. Coagulopathy was defined as prothrombin time test (Quick's value) <70% and/or platelets < 100,000/microl.ResultsFrom a total of 3,114 eligible patients with isolated TBI, 706 (22.7%) presented with coagulopathy upon ER arrival. Coagulopathy was associated with higher rates of craniotomies (P = 0.02), of single and multiple organ failure and with less intubation-free days. In surviving patients, ICU length of stay and hospital length of stay were significantly longer, if coagulopathy had been present at admission. The overall hospital mortality was 50.4% (n = 356) in patients with coagulopathy vs. 17.3% (n = 417) in non-coagulopathic patients (all P < 0.001). Multivariate analysis identified AIS(HEAD) severity grade, GCS or=2,000 ml and age >or=75 years as independent risk factors for coagulopathy after TBI. Acute coagulopathy in TBI had an adjusted odds ratio for hospital mortality of 2.97 (CI(95): 2.30-3.85; P < 0.001).ConclusionCoagulopathy upon ER admission is frequent after isolated blunt TBI and represents a powerful, independent predictor related to prognosis. Future research should aim to determine the beneficial effects of early treatment of TBI-associated coagulopathy.

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