Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury

Oertel, Matthias F.; Kelly, Daniel F.; McArthur, D.A.; Boscardin, W. John; Glenn, Thomas C.; Lee, Jae Hong; Gravori, Tooraj; Obukhov, Dennis; McBride, Duncan Q.; Martin, Neil A.

doi:10.3171/jns.2002.96.1.0109

Cited by 414 publications

(359 citation statements)

References 44 publications

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“…Approximately 25 to 45% of cerebral contusions will enlarge significantly, 6,7 and even higher occurrences are reported if the initial computed tomographic scan is performed within 2 h of injury. 8 The more frequent use of anticoagulant medication and platelet aggregation inhibitors in older patients may further increase the risk of lesion progression. The frequent progression of contusive brain injury indicates that this may constitute a subpopulation of TBI more likely to benefit from neuroprotective agents by limiting processes involved in secondary brain damage.…”

Section: Introductionmentioning

confidence: 99%

Clinical Trials in Traumatic Brain Injury: Past Experience and Current Developments

2010

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Summary:In this article, we review past and current experience in clinical trials of traumatic brain injuries (TBIs), we discuss limitations and challenges, and we summarize current directions. The focus is on severe and moderate TBIs. A systematic literature search of the years from 1980 to 2009 revealed 27 large phase III trials in TBI; we were aware of a further 6 unpublished trials. Analysis of these 33 trials yielded interesting observations:• There was a peak incidence of trial initiations that occurred in the mid-1990s with a sharp decline during the period from 2000 to 2004.• Most trials that reported a significant treatment effect were studies on a therapeutic strategy (e.g., decompressive craniectomy, hypothermia), and these were single-center studies.• Increasingly, studies have been shifting toward the Far East.The currently existing trial registries permit insight into ongoing or recently conducted trials. Compared with the past decade, the number of studies on neuroprotective agents taken forward into efficacy-oriented studies is low. In contrast, the number of studies on therapeutic strategies appears to be increasing again.The disappointing results in trials on neuroprotective agents in TBI have led to a critical reappraisal of clinical trial methodology. This has resulted in recommendations for preclinical workup and has triggered extensive analysis on approaches to improve the design and analysis of clinical trials in TBI. An interagency initiative toward standardization on selection and coding of data elements across the broad spectrum of TBI is ongoing, and will facilitate comparison of research findings across studies and encourage high-quality meta-analysis of individual patient data in the future.

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Section: Introductionmentioning

confidence: 99%

Clinical Trials in Traumatic Brain Injury: Past Experience and Current Developments

2010

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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%

“…1,2 Delayed intracerebral hemorrhage (ICH) is a strong predictor of morbidity and mortality. [3][4][5] Serial computed tomography scans reveal expansion of ICH in ;50% of patients post-TBI, [6][7][8] but intervention based on the current presumptive pathophysiology is often futile.…”

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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“…8,12,13,[15][16][17][18]20 Since the type and extension of the brain injury determine the prognosis and as such injury is subject to deterioration due to impaired hemostasis, the importance and efficacy of treatment of coagulopathy have been widely discussed. [21][22][23] Goodnight et al 9 suggest that the early treatment of coagulopathy may have contributed to a better prognosis of adult patients, which was described by other authors some years later. 6,14 A study with similar results carried out in children younger than 16 years was published only in 2001.…”

Section: Introductionmentioning

confidence: 82%

Distúrbio de coagulação em crianças e adolescentes com traumatismo cranioencefálico moderado e grave

Affonseca¹,

Carvalho²,

Guerra³

et al. 2007

J. Pediatr. (Rio J.)

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Objectives: To describe the epidemiological profile of children and adolescents with moderate to severe traumatic brain injury admitted to an intensive care unit; to describe the frequency of coagulation disorders in these patients; to determine the relationship between coagulopathy and trauma severity; to assess the factors associated with coagulopathy; and to assess the effect of coagulopathy on the mortality of these patients. Methods:Cross-sectional study with 301 patients aged up to 16 years admitted to an intensive care unit due to moderate to severe traumatic brain injury, carried out over a 5-year period. The coagulation profile was associated with clinical, epidemiological and CT findings. Univariate and multivariate analyses were used to check the association between coagulopathy and mortality.Results: Minimum age was 23 days, and maximum age was 16 years (mean of 7.9 years). About 77% of patients had coagulopathy, whose occurrence was directly associated with the severity of the trauma, but not with the rise in mortality. The factors associated with the presence of coagulopathy were the following: severity of the traumatic brain injury (OR = 2.83; 95%CI 1.58-5.07), diagnosis of brain swelling on cranial computed tomography (OR = 2.11; 95%CI 1.13-4.07) and occurrence of chest and/or abdominal injury (OR = 2.07; 95%CI 1.11-4.00). Approximately 35% of patients died. The multivariate analysis showed that the factors associated with an increased risk of death were presence of sodium disorders (OR = 5.56; 95%CI 2.90-10.65), hypotension in the intensive care unit (OR = 12.58; 95%CI 4.40-35.00) and acute respiratory distress syndrome (OR = 13.57; 95%CI 1.51-121.66). Conclusion:The development of coagulopathy is a frequent complication in patients with moderate to severe traumatic brain injury. Even though it is not closely associated with death in this study, it may be regarded as a marker of injury severity.J Pediatr (Rio J). 2007;83(3):274-282: Traumatic brain injury, blood coagulation, child, adolescent.

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Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury

Cited by 414 publications

References 44 publications

Clinical Trials in Traumatic Brain Injury: Past Experience and Current Developments

Clinical Trials in Traumatic Brain Injury: Past Experience and Current Developments

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

Distúrbio de coagulação em crianças e adolescentes com traumatismo cranioencefálico moderado e grave

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