Acute traumatic coagulopathy in the setting of isolated traumatic brain injury: A systematic review and meta-analysis

被引:124
作者
Epstein, Daniel S. [1 ,2 ]
Mitra, Biswadev [1 ,2 ]
O'Reilly, Gerard [1 ,2 ]
Rosenfeld, Jeffrey V. [2 ,3 ,4 ]
Cameron, Peter A. [1 ,2 ,5 ]
机构
[1] Alfred Hosp, Emergency & Trauma Ctr, Melbourne, Vic 3004, Australia
[2] Monash Univ, Dept Epidemiol & Prevent Med, Melbourne, Vic 3004, Australia
[3] Monash Univ, Dept Surg, Melbourne, Vic 3004, Australia
[4] Alfred Hosp, Dept Neurosurg, Melbourne, Vic 3004, Australia
[5] Hamad Med Corp, Emergency Med, Doha, Qatar
来源
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED | 2014年 / 45卷 / 05期
关键词
Wound and injuries; Coagulopathy; Blood coagulation; Traumatic brain injury; Craniocerebral trauma; Brain injuries; Isolated head trauma; HEAD-INJURY; ORGAN FAILURE; FACTOR VIIA; PROTEIN-C; COAGULATION; CLASSIFICATION; HYPOPERFUSION; PATHOGENESIS; PREDICTION; DIAGNOSIS;
D O I
10.1016/j.injury.2014.01.011
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background and objectives: Acute traumatic coagulopathy (ATC) has been reported in the setting of isolated traumatic brain injury (iTBI) and associated with high mortality and poor outcomes. The aim of this systematic review was to examine the incidence and outcome of patients with ATC in the setting of iTBI. Methods: We conducted a search of the MEDLINE database and Cochrane library, focused on subject headings and keywords involving coagulopathy and TBI. Design and results of each study were described. Studies were assessed for heterogeneity and the pooled incidence of ATC in the setting of iTBI determined. Reported outcomes were described. Results: There were 22 studies selected for analysis. A statistically significant heterogeneity among the studies was observed (p < 0.01). Using the random effects model the pooled proportion of patients with ATC in the setting of iTBI was 35.2% (95% CI: 29.0-41.4). Mortality of patients with ATC and iTBI ranged between 17% and 86%. Higher blood transfusion rates, longer hospital stays, longer ICU stays, decreased ventilator free days, higher rates of single and multiple organ failure and higher incidence of delayed injury and disability at discharge were reported among patients with ATC. Conclusions: ATC is commonly associated with iTBI and almost uniformly associated with worse outcomes. Any disorder of coagulation above the normal range appears to be associated with worse outcomes and therefore a clinically important target for management. Earlier identification of patients with ATC and iTBI, for recruitment into prospective trials, presents avenues for further research. (C) 2014 Elsevier Ltd. All rights reserved.
引用
收藏
页码:819 / 824
页数:6
相关论文
共 49 条
[1]   Acute coagulopathy of trauma: mechanism, identification and effect [J].
Brohi, Karim ;
Cohen, Mitchell J. ;
Davenport, Ross A. .
CURRENT OPINION IN CRITICAL CARE, 2007, 13 (06) :680-685
[2]   Acute traumatic coagulopathy: Initiated by hypoperfusion - Modulated through the protein C pathway? [J].
Brohi, Karim ;
Cohen, Mitchell J. ;
Ganter, Michael T. ;
Matthay, Michael A. ;
Mackersie, Robert C. ;
Pittet, Jean-Francois .
ANNALS OF SURGERY, 2007, 245 (05) :812-818
[3]   Subsequent development of thrombocytopenia and coagulopathy in moderate and severe head injury: Support for serial laboratory examination [J].
Carrick, MM ;
Tyroch, AH ;
Youens, CA ;
Handley, T .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2005, 58 (04) :725-729
[4]  
Chang EF, 2006, NEUROSURGERY, V58, P647, DOI 10.1227/01.NEU.0000197101.68538.E6
[5]   Hypofibrinogenemia in isolated traumatic brain injury in Indian patients [J].
Chhabra, Gaurav ;
Rangarajan, Kanchana ;
Subramanian, Arulselvi ;
Agrawal, Deepak ;
Sharma, Subhadra ;
Mukhopadhayay, A. K. .
NEUROLOGY INDIA, 2010, 58 (05) :756-757
[6]   Early coagulopathy after traumatic brain injury: The role of hypoperfusion and the protein C pathway [J].
Cohan, Mitchell Jay ;
Brohi, Karim ;
Ganter, Michael T. ;
Manley, Geoffrey T. ;
Mackersie, Robert C. ;
Pittet, Jean-Francois .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2007, 63 (06) :1254-1261
[7]   Critical Role of Activated Protein C in Early Coagulopathy and Later Organ Failure, Infection and Death in Trauma Patients [J].
Cohen, Mitchell Jay ;
Call, Mariah ;
Nelson, Mary ;
Calfee, Carolyn S. ;
Esmon, Charles T. ;
Brohi, Karim ;
Pittet, Jean Francois .
ANNALS OF SURGERY, 2012, 255 (02) :379-385
[8]   Pathogenesis of acute traumatic coagulopathy [J].
Davenport, Ross .
TRANSFUSION, 2013, 53 :23S-27S
[9]   CRASH-3-tranexamic acid for the treatment of significant traumatic brain injury: study protocol for an international randomized, double-blind, placebo-controlled trial [J].
Dewan, Yashbir ;
Komolafe, Edward O. ;
Mejia-Mantilla, Jorge H. ;
Perel, Pablo ;
Roberts, Ian ;
Shakur, Haleema .
TRIALS, 2012, 13
[10]   Haemostatic and cranial computed tomography characteristics in patients with acute and delayed coagulopathy after isolated traumatic brain injury [J].
Franschman, Gaby ;
Greuters, Sjoerd ;
Jansen, Wim H. ;
Posthuma, Linda M. ;
Peerdeman, Saskia M. ;
Wattjes, Mike P. ;
Loer, Stephan A. ;
Boer, Christa .
BRAIN INJURY, 2012, 26 (12) :1464-1471