Delayed Brain Injury after Head Trauma

Stein, Sherman C.; Young, Gary; Talucci, Raymond C.; Greenbaum, Barbara H.; Ross, Steven E.

doi:10.1097/00006123-199202000-00002

Cited by 86 publications

(103 citation statements)

References 34 publications

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“…There are variable data in the literature and different studies associated one or more of the following with TBI progression: Prothrombin time (PT) or INR, Partial thromboplastin time (PTT), thrombocytopenia, high fibrin degradation and low fibrinogen levels. [25][26][27][28][29][30] Fewer other studies reported no association between coagulopathy and bleeding progression in TBI. [31][32][33] This considerable variation is attributed to lack of consensus on TBI-coagulopathy definition, heterogeneity of patients involved, variable laboratory tests used in different studies and timing to perform these tests and CTs.…”

Section: Coagulopathy and Edhpmentioning

confidence: 98%

Epidural Hematoma Treated Conservatively: When to Expect the Worst

Basamh

Robert

Lamoureux

et al. 2015

Can. J. Neurol. Sci.

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Background: The Brain Trauma Foundation's 2006 surgical guidelines have objectively defined the epidural hematoma (EDH) patients who can be treated conservatively. Since then, the literature has not provided adequate clues to identify patients who are at higher risk for EDH progression (EDHP) and conversion to surgical therapy. The goal of our study was to identify those patients. Methods: We carried a retrospective review over a 5-year period of all EDH who were initially triaged for conservative management. Demographic data, injury severity and history, neurological status, use of anticoagulants or anti-platelets, radiological parameters, conversion to surgery and its timing, and Glasgow Outcome Scale were analyzed. Bivariate association and further logistic regression were used to point out the significant predictors of EDHP and conversion to surgery. Results: 125 patients (75% of all EDH) were included. The mean age was 39.1 years. The brain injury was mild in 62.4% of our sample and severe in 14.4%. Only 11.2% of the patients required surgery. Statistical comparison showed that younger age (p < 0.0001) and coagulopathy (p = 0.009) were the only significant factors for conversion to surgery. There was no difference in outcomes between patients who had EDHP and those who did not. Conclusions: Most traumatic EDH are not surgical at presentation. The rate of conversion to surgery is low. Significant predictors of EDHP are coagulopathy and younger age. These patients need closer observation because of a higher risk of EDHP. Outcome of surgical conversion was similar to successful conservative management.RÉSUMÉ: Hématome épidural traité de façon conservatrice : quand s'attendre au pire. Contexte : Les lignes directrices chirurgicales de la Brain Trauma Foundation de 2006 ont défini objectivement les patients atteints d'un hématome épidural (HÉD) qui peuvent être traités de façon conservatrice. Depuis lors, il n'existe pas dans la littérature d'indices adéquats pour identifier les patients qui sont à plus haut risque de progression de l'HÉD et chez qui un traitement chirurgical doit être envisagé. Le but de notre étude était d'identifier ces patients. Méthode : Nous avons effectué une revue rétrospective sur une période de 5 ans des dossiers de tous les patients atteints d'un HÉD qui ont été assignés initialement au traitement conservateur. Nous avons analysé les données démographiques, la sévérité de la lésion et son historique, l'état neurologique, la prise d'anticoagulants ou d'antiplaquettaires, les paramètres radiologiques, le recours à un traitement chirurgical et le moment où il a été réalisé ainsi que le score au Glasgow Outcome Scale. L'analyse bivariée ainsi que l'analyse de régression logistique ont été utilisées pour déterminer les facteurs de prédiction significatifs de la progression de l'HÉD et du recours à la chirurgie. Résultats : Cent vingt-cinq patients (75% des patients atteints d'un HÉD) ont été inclus dans l'étude. L'âge moyen des patients était de 39,1 ans. La lésion cérébrale étai...

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Section: Coagulopathy and Edhpmentioning

confidence: 98%

Epidural Hematoma Treated Conservatively: When to Expect the Worst

Basamh

Robert

Lamoureux

et al. 2015

Can. J. Neurol. Sci.

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“…3,9,10 In support of this concept, high levels of D-dimers, prolongation of clotting times, thrombocytopenia, and increased plasmin/anti-plasmin complexes correlate with increased mortality. 7,11,12 However, measures that attenuate the consumptive coagulopathy fail to reduce mortality and/or disability. 9,10 Thus, important gaps in our understanding of the pathophysiology and management of post-TBI bleeding persist 13,14 and there is continued need to examine other possible causes.…”

Section: Introductionmentioning

confidence: 99%

Endogenous plasminogen activators mediate progressive intracerebral hemorrhage after traumatic brain injury in mice

Hijazi¹,

Fanne²,

Abramovitch

et al. 2015

Blood

116

115

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“…Abnormalities in admission PT, aPTT, INR, and fibrinogen degradation products have all been linked to increased morbidity and mortality in TBI patients [3,4,7,12,27,28,[32][33][34][35][36][37]. However, when we analyzed admission CCT values on 1924 of our highest-level trauma activations over 18 months, no statistically significant difference in the prevalence of coagulopathy based on these values was detected in TBI patients compared to non-TBI patients (Table 2).…”

Section: Discussionmentioning

confidence: 98%