| Multicenter evaluation of the course of coagulopathy in patients with isolated traumatic brain injury: relation to CT characteristics and outcome. | |
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MedLine Citation:
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PMID: 21939390 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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This prospective multicenter study investigated the association of the course of coagulation abnormalities with initial computed tomography (CT) characteristics and outcome in patients with isolated traumatic brain injury. Patient demographics, coagulation parameters, CT characteristics and outcome data of moderate and severe TBI patients without major extracranial injuries were prospectively collected. Coagulopathy was defined as absent, early but temporary, delayed or early and sustained. Delayed/sustained coagulopathy was associated with a higher incidence of disturbed pupillary responses (40% vs. 27%; P<0.001) and higher Traumatic Coma Data Bank (TCDB) CT classification (5 (2-5) vs. 2 (1-5); P=0.003) than in patients without or with early, but short-lasting coagulopathy. The initial CT of patients with delayed/sustained coagulopathy more frequently showed intracranial hemorrhage and signs of raised intracranial pressure compared to patients with early coagulopathy only. This was paralleled by higher in-hospital mortality rates (51% vs. 33%; P<0.05) and poorer 6-month functional outcome in patients with delayed/sustained coagulopathy. The relative risk for in-hospital mortality was particularly related to disturbed pupillary responses (OR 8.19; 95% CI 3.15-21.32; P<0.001), early, short-lasting coagulopathy (OR 6.70; 95% CI 1.74-25.78; P=0.006) or delayed/sustained coagulopathy (OR 5.25; 95% CI 2.06-13.40; P=0.001). Delayed/sustained coagulopathy is more frequently associated with CT abnormalities and unfavorable outcome at 6 months after TBI than early, short-lasting coagulopathy. Our finding that not only the mere presence but also the time course of coagulopathy holds predictive value for patient outcome underlines the importance of systematic hemostatic monitoring over time in TBI. |
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Authors:
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Gaby Franschman; Christa Boer; Teuntje Andriessen; Joukje Van der Naalt; Janneke Horn; Iain Haitsma; Bram Jacobs; Pieter E Vos |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-9-22 |
Journal Detail:
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Title: Journal of neurotrauma Volume: - ISSN: 1557-9042 ISO Abbreviation: - Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-9-23 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8811626 Medline TA: J Neurotrauma Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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VU University Medical Center, Anesthesiology, de Boelelaan 1117, Amsterdam, Netherlands, 1081HV, +31204444386; g.franschman@vumc.nl. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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