D. Shah2, D. Hanseman1, C. Zammit3, T. Pritts1, A. Makley1, B. Foreman3, M. Goodman1 1University Of Cincinnati,Division Of Trauma And Critical Care,Cincinnati, OH, USA 2University Of Cincinnati,College Of Medicine,Cincinnati, OH, USA 3University Of Cincinnati,Neurology & Rehabilitation Medicine,Cincinnati, OH, USA
Introduction: Acute coagulopathy and platelet dysfunction commonly develop after traumatic brain injury (TBI). Thromboelastography (TEG) and platelet function assays (PFAs) can be performed upon admission to assess the risks of continued intracranial bleeding and injury progression. The role of TEG and PFA in assessing post-TBI coagulopathy has not been investigated. We hypothesized that, compared to blunt injuries, penetrating head injuries would (1) demonstrate greater coagulopathy by TEG, (2) be associated with altered platelet function assay results and (3) require more blood products after TBI.
Methods: Retrospective study of all patients admitted to the neurosurgical intensive care unit (NSICU) of a Level 1 trauma center from January 2013 through December 2015 with a head AIS ≥ 3. Patients were compared by mechanism of injury (blunt vs penetrating). Admission demographics, injury characteristics, and lab parameters, including blood gas, TEG, and PFAs, were evaluated. VerifyNow® Aspirin and P2Y12 tests were used for platelet function and potential inhibitor analysis. Admission labs were included if performed within 2 hours of hospital admission. Student’s t-tests were used to analyze quantitative differences between labs and groups. Pearson correlation coefficients were calculated between platelet count, PFA results and TEG results.
Results: 534 patients were included in the analysis (485 blunt and 49 penetrating). There were no differences between groups in platelet count or INR upon admission. Patients with penetrating TBI were more coagulopathic by TEG, with all of the TEG parameters being significantly different except for R-time (Table). There were no differences in PFA results between blunt and penetrating groups, and the PFAs did not correlate to any TEG parameter in either TBI group. Additionally, the penetrating TBI group received more units of PRBCs in the first 4 hours (mean 0.67 vs 0.17 units, p<0.01) and plasma in the first 24 hours (mean 0.83 vs 0.25 units, p=0.046) than the blunt TBI group. There were no differences in platelet or cryoprecipitate use between TBI groups.
Conclusion: Patients presenting with a penetrating TBI demonstrate increased coagulopathy as compared to those with blunt TBI. Penetrating TBI patients received more blood products within the first 24 hours. Platelet testing did not correlate to TEG findings in this population. Routine admission TEG, but not VerifyNow PFA, may be utilized to demonstrate posttraumatic coagulopathy and determine the need for targeted blood product administration after TBI.
