TRAUMATIC COAGULOPATHY INFLUENCES OUTCOME IN PATIENTS WITH ISOLATED TRAUMATIC BRAIN INJURY

Objectives & BackgroundThe coagulopathy associated with severe trauma and shock (ACOTS) has been well-described over the last decade. Recently a similar coagulopathy has been identified in patients with isolated traumatic brain injury (iTBI) in the absence of shock. The aim of this study was to identify whether or not ACOTS is detectable on admission in patients with iTBI admitted to a UK Major Trauma Centre and to explore associations with outcome.Table 1ACOTS (n=52)No ACOTS (n=56)p-valueAge60.6 (3.3)62.7 (3.3)NSMale29 (43.9%)37 (56.1%)NSMechanism Blow5 (9.6%)6 (10.7%)NSMechansim fall 2m8 (15.4%)2 (3.6%)Mechansim RTC5 (9.6%)6 (10.7%)Intracranial injury Extradural4 (7.6%)2 (3.6%)NSIntracranial Injury Intraparenchymal5 (9.6%)5 (8.9%)Intracranial Injury Mixed25 (48%)28 (50%)Intracranial Injury SAH4 (7.6%)9 (16%)Intracranial Injury Subdural12 (23%)12 (21.4)%Outcome Death14 (26.9%)3 (5.4%)p=0.002Outcome Good recovery GOS18 (34.6%)27 (48.2%)p=0.02AIS head 35 (9.6%)4.36 (10.7%)NSAIS head 417 (32.7%)28 (50%)AIS head 529 (55.8%)22 (39.3%)AIS head 61 (1.9%)0Length of stay (days)13.212.9NSITU length of stay (days)2.71.8NSAdmission GCS (median)1414NSAdmission CRP (mg/l)62.818.80.04MethodsA retrospective search of the local Trauma Audit Research Network (TARN) dataset was undertaken to identify patients with iTBI (AIS head>2, no other injury AIS>2) who presented to Derriford Hospital from 01 January to 31 December 2014. Demographic, mechanistic, physiological, resource utilisation and outcome data were recorded alongside admission laboratory blood test results. Cases were included if they had a FBC and lab coagulation screen performed on the day of admission. Cases therapeutically anticoagulated prior to admission or those transferred more than 24 hours following injury were excluded from analysis. ACOTS was defined as either PT>1.5s or APTT>35s or INR>1.2 or platelets