The Association between Blood Coagulation Parameters and Glasgow Coma Scale in Patients with Head Trauma Admitted to Intensive Care Unit

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Traumatic brain injury as one of the main causes of mortality and disability is associated with changes in blood coagulation parameters and coagulopathy. Therefore, in this study, we aimed to investigate the association between prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), and platelet count with Glasgow coma scale (GCS) in patients with brain trauma.Methods: In this prospective study, 120 patients with a brain injury admitted to intensive care units (ICU) of Alzahra hospital in Isfahan, Iran, were randomly selected. PT, PTT, INR, and platelet counts were measured at the time of admission to the intensive care unit and 24 hours after it.Findings: At the beginning of admission to intensive care unit, GCS had a significant correlation with platelet count (r = 0.31, P < 0.010), and reverse and significant correlation with PT (r = -0.29, P = 0.001), PTT (r = -0.32, P < 0.010), and INR (r = -0.29, P = 0.001). Similarly, 24 hours after admission to the intensive care unit, GCS had a direct and significant correlation with platelet count and also a significant and inverse correlation with PT, PTT, and INR (P < 0.050 for all).Conclusion: GCS has a direct correlation with blood platelet level, and has an inverse correlation with PT, PTT, and INR, and therefore, these blood coagulation parameters can be used to predict the severity of brain trauma in patients with head trauma.

Keywords


  1. Martin GT. Acute brain trauma. Ann R Coll Surg Engl 2016; 98(1): 6-10.
  2. Vakil MT, Singh AK. A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment. Emerg Radiol 2017; 24(3): 301-9.
  3. Dash HH, Chavali S. Management of traumatic brain injury patients. Korean J Anesthesiol 2018; 71(1): 12-21.
  4. Haghbayan H, Boutin A, Laflamme M, Lauzier F, Shemilt M, Moore L, et al. The prognostic value of MRI in moderate and severe traumatic brain injury: A systematic review and meta-analysis. Crit Care Med 2017; 45(12): e1280-e1288.
  5. Pearn ML, Niesman IR, Egawa J, Sawada A, Almenar-Queralt A, Shah SB, et al. Pathophysiology associated with traumatic brain injury: Current treatments and potential novel therapeutics. Cell Mol Neurobiol 2017; 37(4): 571-85.
  6. Abraham P, Rennert RC, Gabel BC, Sack JA, Karanjia N, Warnke P, et al. ICP management in patients suffering from traumatic brain injury: A systematic review of randomized controlled trials. Acta Neurochir (Wien) 2017; 159(12): 2279-87.
  7. El-Menyar A, Mekkodathil A, Al-Thani H, Consunji R, Latifi R. Incidence, demographics, and outcome of traumatic brain injury in the Middle East: A systematic review. World Neurosurg 2017; 107: 6-21.
  8. Xie Q, Wu HB, Yan YF, Liu M, Wang ES. Mortality and outcome comparison between brain tissue oxygen combined with intracranial pressure/cerebral perfusion pressure-guided therapy and intracranial pressure/cerebral perfusion pressure-guided therapy in traumatic brain injury: A meta-analysis. World Neurosurg 2017; 100: 118-27.
  9. Bergersen K, Halvorsen JO, Tryti EA, Taylor SI, Olsen A. A systematic literature review of psychotherapeutic treatment of prolonged symptoms after mild traumatic brain injury. Brain Inj 2017; 31(3): 279-89.
  10. Joseph B, Khan M, Rhee P. Non-invasive diagnosis and treatment strategies for traumatic brain injury: an update. J Neurosci Res 2018; 96(4): 589-600.
  11. Laskowitz D, Grant G. Translational research in traumatic brain injury. Boca Raton, FL: CRC Press; 2016.
  12. Hawryluk GW, Manley GT. Classification of traumatic brain injury: Past, present, and future. Handb Clin Neurol 2015; 127: 15-21.
  13. Kim HJ, Tsao JW, Stanfill AG. The current state of biomarkers of mild traumatic brain injury. JCI Insight 2018; 3(1).
  14. Maegele M, Schochl H, Menovsky T, Marechal H, Marklund N, Buki A, et al. Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management. Lancet Neurol 2017; 16(8): 630-47.
  15. Yuan Q, Sun YR, Wu X, Yu J, Li ZQ, Du ZY, et al. Coagulopathy in traumatic brain injury and its correlation with progressive hemorrhagic injury: A systematic review and meta-analysis. J Neurotrauma 2016; 33(14): 1279-91.
  16. Salehpour F, Bazzazi AM, Porhomayon J, Nader ND. Correlation between coagulopathy and outcome in severe head trauma in neurointensive care and trauma units. J Crit Care 2011; 26(4): 352-6.
  17. Sun Y, Wang J, Wu X, Xi C, Gai Y, Liu H, et al. Validating the incidence of coagulopathy and disseminated intravascular coagulation in patients with traumatic brain injury--analysis of 242 cases. Br J Neurosurg 2011; 25(3): 363-8.
  18. Schuelke GS, Chaperon EA, Sanders WE, Jr. Effects of common analgesics on the in vitro suppression of lymphocyte mitogen responses by cephalosporins. Antimicrob Agents Chemother 1982; 21(6): 995-8.
  19. Kashefi P, Abbasi S, Alikiaii B, Kouhi H. prevalence of coagulopathy and related risk factors in patients with trauma hospitalized in intensive care units of Alzahra Hospital, Isfahan, Iran, during 2013-2016. J Isfahan Med Sch 2017; 35(447): 1256-62. [In Persian].