Medical Student Vanderbilt University School of Medicine Nashville, Tennessee, United States
Introduction: Coagulation parameters in TBI have been an area of interest as disseminated intravascular coagulation commonly follows TBI. The purpose of the present study is to provide an assessment of the utility of admission platelets, prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), and serum magnesium on predicting clinical outcomes for TBI.
Methods: TBI patients from January 1st-December 31st, 2017 were retrospectively reviewed at a Level 1 trauma center. Primary outcome included favorable discharge GCS (> 13). Optimal cutoff points for continuous variables were determined using Euclidean distance analysis onto favorable discharge GCS. General linear multivariable models adjusted for confounders, including age, gender, injury severity score, neurosurgical intervention, and admission GCS were used. Sub-analysis was conducted for intraparenchymal hemorrhage (IPH), subdural hemorrhage (SDH), and subarachnoid hemorrhage (SAH).
Results: A total of 131 patients were included in the analysis (GCS range 3 – 15), of which 104 (79%) patients experienced a good neurological outcome. Those with good neurological outcome experienced no significant differences in mean values. Threshold analysis identified significant cutoffs for PT >/= 12.5, INR >/= 1.2, and platelets >/= 148, as well as insignificant cutoffs for PTT >/= 28.8 and magnesium >/= 1.8 in a univariate analysis for discharge GCS. In the sub-analysis for associated bleeding, platelets >/= 148 remained a significant predictor of lower odds of expansion of IPH, SAH, and SDH. After multivariate adjustment revealed platelets >/= 148 was a significant predictor of good neurological outcome (OR = 6.25, 95% CI [1.66, 26.9], p = 0.009).
Conclusion : The results suggest that admission values for clotting parameters, especially platelet count, are significant in the prediction of neurological outcomes as well as future clinical events such as intracranial bleeding and that patients may benefit from aggressive initial management.
