Introduction: Coagulopathy is commonly observed after traumatic brain injury (TBI). However, it is not known whether using the standard independent predictors in conjunction with coagulation tests would improve their prognostic value. We determined the incidence of TBI-associated coagulopathy in patients with isolated TBI (iTBI),
evaluated the prognostic value of coagulation tests for in-hospital mortality, and tested their predictive power for in-hospital mortality in patients with iTBI.
Methods: We conducted a retrospective, observational database study on 2319 consecutive patients with iTBI who
attended the Huashan Hospital Department of the Neurosurgery Neurotrauma Center at Fudan University in China
between December 2004 and June 2015. Two models based on the admission characteristics were developed:
model A included predictors such as age, Glasgow Coma Scale (GCS) score, pupil reactivity, type of injury, and
hemoglobin and glucose levels, while model B included the predictors from model A as well as coagulation test
results. A total of 1643 patients enrolled between December 2004 and December 2011 were used to derive the
prognostic models, and 676 patients enrolled between January 2012 and June 2015 were used to validate the
models.
Results: Overall, 18.6% (n = 432) of the patients developed coagulopathy after iTBI. The prevalence of acute traumatic
coagulopathy is associated with the severity of brain injury. The percentage of platelet count <100 × 109/L,
international normalized ratio (INR) > 1.25, the prothrombin time (PT) > 14 s, activated partial thromboplastin
time (APTT) > 36 s, D-dimer >5 mg/L and fibrinogen (FIB) < 1.5 g/L was also closely related to the severity of
brain injury, significance being found among three groups. Age, pupillary reactivity, GCS score, epidural
hematoma (EDH), and glucose levels were independent prognostic factors for in-hospital mortality in model
A, whereas age, pupillary reactivity, GCS score, EDH, glucose levels, INR >1.25, and APTT >36 s exhibited
strong prognostic effects in model B. Discrimination and calibration were good for the development group in
both prediction models. However, the external validation test showed that calibration was better in model B
than in model A for patients from the validation population (Hosmer–Lemeshow test, p = 0.152 vs. p = 0.046,
respectively).
Conclusions: Coagulation tests can improve the predictive power of the standard model for in-hospital
mortality after TBI.
Patient Care: We believe our findings highlight the importance of
including coagulation test results in state-of-the-art outcome
prediction models and set the stage for using this
approach in future large-scale clinical trials. Moreover,
we believe our results pave the way for the development
of tools that connect basic science and clinical research
with clinical evidence-based decision making that will
ultimately improve the care of patients with TBI.
Learning Objectives: We determined the incidence of TBI-associated coagulopathy in patients with isolated TBI (iTBI),
evaluated the prognostic value of coagulation tests for in-hospital mortality, and tested their predictive power for in-hospital mortality in patients with iTBI.