A Study to Explore the Extent of Coagulation Profile and its Correlation with the Severity of TBI

AbstractAim: The aim of the present study was to explore the extent of coagulation profile derangements, its correlationwith the severity of TBI, and clinical outcome.Methods: The study was performed on patients with isolated head injury in department of General Surgery forone year . A total of 100 patients in the age group of 20 to 70 years were studied.Results: Majority of the patients belonged to the age group 41-50 years followed by 51-60 years. 80% were maleand 20% were females in the present study. Road traffic accident was the primary (75%) mode of injury. Inpatients with MHI, 64% of the study population had coagulopathy while 48% of the patients with SHI were foundto have coagulation abnormalities. The patients with SHI were divided into two groups. The first group included40 patients and had GOS 1 or GOS 2. The second group included 8 patients and had GOS 5. p-Value for DICscore was &lt; 0.001 and is statistically significant. p-Value in both PT and APTT was &lt; 0.05 and was significant.However, it was not significant for D-dimer, fibrinogen, and platelet counts. In patients with MHI, p-value in caseof DIC score, platelet count, APTT, and D-dimer was &lt; 0.001 and was highly significant. p-Value in PT was &lt;0.05 and found to be statistically significant, however, it was not significant for fibrinogen.Conclusion: The patients of isolated head injury are at high risk of developing coagulation abnormalities.Coagulopathy is directly associated with the severity of TBI, GCS, and is independently associated with pooroutcome. DIC score is a useful parameter in the prediction of prognosis of head injury patients. The timelyintervention in such patients can help improve prognosis. The analysis of coagulation parameters are usefulpredictors of outcome and can be used to explain the relatives about prognosis and course of the patient duringthe hospital stay摘要 研究目的：本研究旨在探讨凝血谱异常的发生程度、其与创伤性脑损伤（TBI, Traumatic Brain Injury）严重程度的相关性，以及与临床结局的关联。 研究方法：本研究于普外科病房开展，纳入为期1年的单纯性头部损伤患者，共纳入20~70岁年龄段患者100例。 研究结果：本研究对象中，多数患者年龄介于41~50岁，其次为51~60岁；男性占比80%，女性占比20%。道路交通伤为最主要的致伤原因（75%）。在轻度创伤性脑损伤（MHI, Mild Head Injury）患者中，64%的研究对象出现凝血病；而在重度创伤性脑损伤（SHI, Severe Head Injury）患者中，48%存在凝血功能异常。研究将重度创伤性脑损伤患者分为两组：第一组共40例，格拉斯哥预后评分（GOS, Glasgow Outcome Scale）为1分或2分；第二组共8例，格拉斯哥预后评分为5分。弥散性血管内凝血（DIC, Disseminated Intravascular Coagulation）评分的P值<0.001，具有统计学显著性；凝血酶原时间（PT, Prothrombin Time）与活化部分凝血活酶时间（APTT, Activated Partial Thromboplastin Time）的P值均<0.05，差异具有统计学意义，但D-二聚体、纤维蛋白原及血小板计数的差异无统计学意义。在轻度创伤性脑损伤患者中，弥散性血管内凝血评分、血小板计数、活化部分凝血活酶时间及D-二聚体的P值均<0.001，差异具有高度统计学显著性；凝血酶原时间的P值<0.05，差异具有统计学意义，但纤维蛋白原的差异无统计学意义。 研究结论：单纯性头部损伤患者发生凝血功能异常的风险较高。凝血病与创伤性脑损伤严重程度、格拉斯哥昏迷评分（GCS, Glasgow Coma Scale）直接相关，且与不良临床结局独立相关。弥散性血管内凝血评分可有效预测头部损伤患者的预后，对该类患者及时干预有助于改善预后。凝血功能参数分析可作为预后的有效预测指标，亦可用于向患者家属解释患者住院期间的病情进程与预后情况。