Haemostatic activation in patients with head injury with and without simultaneous multiple trauma

Sørensen, Jesper Roed; Jensen, Hans Peter; Rahr, Hans B; Borris, Lars C.; Lassen, Michael R.; Fedders, O.; Haase, Jens; Knudsen, Flemming

doi:10.3109/00365519309092568

Cited by 29 publications

(16 citation statements)

References 30 publications

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“…Furthermore, although the association between coagulopathy and the severity of head injury and clinical outcome has been reported among adults [6, 7, 8, 9, 10], it has not been extensively studied among children. Nonetheless, two published studies do suggest that coagulopathy can be a serious complication among children with head injury [1, 11].…”

Section: Introductionmentioning

confidence: 99%

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

et al. 2001

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Background: Although disseminated intravascular coagulation (DIC) and other hemocoagulative abnormalities are severe complications of head injury, their effect on clinical outcome remains unclear, particularly among children. Objectives: To evaluate the frequency of hemocoagulative abnormalities and their influence on outcome among children with head injury. Study Design: We conducted a prospective observational study among 60 children with head injury, immediately evaluating severity of head injury (Glasgow Coma Scale, GCS); cerebral axial tomography; prothrombin time; activated partial thromboplastin time (aPTT); fibrinogen level; concentration of fibrin-fibrinogen degradation products (FDP), and platelet count. Two months after injury, we applied the Glasgow Outcome Score (GOS). Associations with GOS were evaluated using univariate and multivariate logistic models. Results: Among children with severe head injury, 22.2% (6/27) developed DIC, all of whom died and had shown severe brain edema. Among those with severe head injury yet without DIC, the mortality was only 14.2%. A low GOS was significantly and independently associated with a low GCS, multiple trauma, delayed aPTT, low fibrinogen level, elevated FDP and low platelet count. Brain edema was also associated with a low GOS, though not significantly. Conclusions: In addition to GCS, type of trauma, type of brain lesion and certain coagulation abnormalities are predictors of GOS.

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Section: Introductionmentioning

confidence: 99%

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

et al. 2001

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“…[1] The definitions of coagulopathy have been changed over time, and in addition, other techniques for measuring DIC have become available in the last decade. [15] DIC scores have been used to assess the coagulation status of a patient in many studies.…”

Section: Discussionmentioning

confidence: 99%

“…[1] The factors contributing to post traumatic coagulopathy also include severe acidosis, hypotension, hypothermia, massive transfusion as well as massive tissue injury. [1–4] Severe head injury is one of the most important causes of derangement of coagulation profile post trauma mainly due to the release of tissue thromboplastin. Various studies have convincingly shown that moderate and severe head injury is often complicated by disseminated intravascular coagulation (DIC) and thrombocytopenia.…”

Section: Introductionmentioning

confidence: 99%

Coagulation studies in patients with orthopedic trauma

Rangarajan

Subramanian

Gandhi

et al. 2010

J Emerg Trauma Shock

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Background:Head injury, severe acidosis, hypothermia, massive transfusion and hypoxia often complicate traumatic coagulopathy. First line investigations such as prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen level, platelet count and D-dimer levels help in the initial assessment of coagulopathy in a trauma victim.Aim:To study the coagulation profile in patients of orthopedic trauma.Settings and Design:Prospective study.Patients and Methods:Patients with head injury, severe acidosis, massive transfusion and severe hypoxia were excluded from the study. Coagulation parameters were evaluated at three intervals, at the time of admission, intra operatively and in the postoperative period.Statistical Analysis:Chi-square test was used for analysis of categorical variables. For comparison between groups, two- way ANOVA was used.Results and Conclusions:Of the 48 patients studied, 38 (80%) had normal DIC scores upon admission and only 10 (20%) had mild DIC scores at the time of admission. The median Injury Severity Score was 34 and they did not correlate with DIC scores. Fibrinogen levels alone were significantly different, increased progressively (mean pre op, intra op and post op levels 518 ± 31,582 ± 35 and 643 ± 27 respectively; P ≤ 0.02) since the time of admission in these patients. All the other parameters remained unchanged. Further large scale prospective studies would be required to correlate elevated fibrinogen levels with the type of trauma or surgery.

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“…But some authors [1,2] reported that the activation of coagulation and fibrinolysis after head injury is not the specific phenomenon comparing with the population of trauma victim. Recently, we have been able to measure some molecular markers of coagulation and fibrinolysis system in clinical setting.…”

Section: Introductionmentioning

confidence: 99%