Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA.
Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA.
Neurocrit Care. 2018 Jun;28(3):330-337. doi: 10.1007/s12028-017-0485-5.
Coagulopathy and platelet dysfunction commonly develop after traumatic brain injury (TBI). Thromboelastography (TEG) and platelet function assays (PFAs) are often performed at the time of admission; however, their roles in assessing post-TBI coagulopathy have not been investigated. We hypothesized that compared to blunt TBI, penetrating TBI would (1) demonstrate greater coagulopathy by TEG, (2) be associated with abnormal PFA results, and (3) require more blood product transfusions.
We performed a retrospective study of patients admitted to the neuroscience intensive care unit of a level 1 trauma center from 2013 to 2015 with head Abbreviated Injury Scale ≥3. Patients were compared by mechanism of injury (blunt vs. penetrating). Admission demographics, injury characteristics, and laboratory parameters were evaluated. VerifyNow Aspirin and P2Y12 tests were used for platelet function analysis.
Five hundred and thirty-four patients were included in the analysis. There were no differences between groups in platelet count or international normalized ratio; however, patients with penetrating TBI were more coagulopathic by TEG, with all of the TEG parameters being significantly different except for R time. Patients with penetrating head trauma were not more likely than their blunt counterparts to have abnormal PFA results, and PFA results did not correlate with any TEG parameter in either group. The penetrating cohort received more units of blood products in the first 4 and 24 h than the blunt cohort.
Patients presenting with penetrating TBI demonstrated increased coagulopathy compared to those with blunt TBI as measured by TEG and need for transfusion. PFA results did not correlate with TEG findings in this population.
颅脑创伤（TBI）后常发生凝血功能障碍和血小板功能障碍。血栓弹力图（TEG）和血小板功能检测（PFA）常于入院时进行；然而，它们在评估 TBI 后凝血功能障碍中的作用尚未得到研究。我们假设，与钝性 TBI 相比，穿透性 TBI 会：（1）通过 TEG 显示出更大的凝血功能障碍，（2）与异常的 PFA 结果相关，（3）需要更多的血液制品输注。
我们对 2013 年至 2015 年期间在 1 级创伤中心神经重症监护病房收治的头部损伤严重程度评分（Abbreviated Injury Scale）≥3 的患者进行了回顾性研究。通过损伤机制（钝性 vs. 穿透性）对患者进行比较。评估入院时的人口统计学、损伤特征和实验室参数。使用 VerifyNow Aspirin 和 P2Y12 检测进行血小板功能分析。
共纳入 534 例患者。两组患者的血小板计数或国际标准化比值无差异；然而，穿透性 TBI 患者的 TEG 表现更为凝血功能障碍，除 R 时间外，所有 TEG 参数均有显著差异。穿透性头部创伤患者的 PFA 结果异常并不比钝性头部创伤患者更常见，且 PFA 结果与两组任何 TEG 参数均无相关性。与钝性 TBI 患者相比，穿透性 TBI 患者在入院后 4 小时和 24 小时内需要输注更多的血液制品。
与钝性 TBI 相比，穿透性 TBI 患者的 TEG 检测显示出更严重的凝血功能障碍和输血需求。在该人群中，PFA 结果与 TEG 发现不相关。
