OC 11.2 - Functional characterisation of coagulopathy in isolated traumatic brain injury

Sunday, July 10, 2022

11:00 AM – 11:15 AM

Location: ExCel Center, ICC Auditorium

Presentation Format: In-Person

Presenting Author(s)

Charlotte Lindsay, MSc

Clinical Research Fellow
Queen Mary University of London
London, England, United Kingdom

Co-Author(s)

JR

Jennifer Ross

Clinical research fellow
Centre for Trauma Sciences, Queen Mary University of London
London, England, United Kingdom
HT

Harriet Tucker

Clinical Research Fellow
Centre for Trauma Sciences, Queen Mary University of London
London, England, United Kingdom
AR

Andrea Rossetto

PhD student
Centre for Trauma Science, Blizard Institute, Queen Mary University, London, United Kingdom
London, England, United Kingdom
MC

Michael Carver

Clinical Research Fellow
Centre for Trauma Sciences, Queen Mary University of London
London, England, United Kingdom
JP

Jason Pott

Clinical research fellow
Centre for trauma sciences, Queen Mary University of London
London, England, United Kingdom
AA

Ateeq Almuwallad

Clinical Research Fellow
Centre for Trauma Sciences
London, England, United Kingdom
RS

Rebecca Stoner

Clinical Research Fellow
Centre for Trauma Sciences, Queen Mary University of London
London, England, United Kingdom
JW

Jared Wohlgemut

Clinical Research Fellow
Centre for Trauma Sciences, Queen Mary University of London
London, England, United Kingdom
RD

Ross Davenport

Senior Clinical Lecturer/Consultant Trauma Surgeon
Centre for Trauma Sciences, Queen Mary University of London
London, England, United Kingdom
Karim Brohi, FRCS FRCA

Chair of Trauma Sciences
Queen Mary University of London
London, England, United Kingdom

Background: The existence and nature of a coagulopathy associated with isolated Traumatic Brain Injury (iTBI) remains unclear. However, recent randomised controlled trials suggest that iTBI may be more common and important than has previously been appreciated.

Aims: We aimed to describe the coagulation abnormalities present on admission in iTBI patients; iTBI characteristics associated with their development; and their relationship with outcomes in terms of intracranial pressure (ICP), 7-day progression of intracranial haemorrhage (ICH), and mortality.

Methods: We analysed admission coagulation tests from a subgroup of iTBI patients (Head Abbreviated Injury Score of 3 or higher, and below 3 in all other body regions) enrolled in the ACIT prospective observational study of coagulopathy and inflammation in trauma (REC 07/Q0603/2). Evidence of raised ICP was defined as ICP>25mmHg or basal cistern compression on CT. We used modified Rotterdam Scoring to explore the combined effect of injury burden and signs of raised ICP on coagulation.

Results: 237 patients had with severe iTBI. At least one coagulation abnormality was present in 66% of individuals, EXTEM CA5 < 40mm (45%), EXTEM ML < 5% (44%), fibrinogen < 2g/L (38%) and EXTEM CT>80s (29%). Coagulation abnormalities were more common in those with the highest modified Rotterdam score than the lowest (86% vs 55%), head AIS 5 versus 3 (70% vs 62%) and with raised ICP (80% vs 60%). Coagulation abnormalities were present in a greater proportion of patients with adverse outcomes, across a range of tests (table 1). The presence of any coagulation abnormality was associated with evidence of increased ICP (31% vs 16.3%), 7-day progression of ICH (67% vs 51%) and higher 7-day mortality (21% vs 7.5%).

Conclusion(s): Admission iTBI coagulopathy is common and associated with severity and raised ICP on admission. ITBI coagulopathy was associated with substantially worse outcomes and represents a potential opportunity for therapeutic intervention.