Severity of injury as assessed by glasgow coma score and coagulopathy in patients with isolated head trauma

Meera Sikka., Ruchika Sodhi., Mrinalini Kotru and Gurubachan Singh

The outcome of patients with Traumatic brain injury (TBI) is affected by hemostatic derangements which contribute not only to mortality but also morbidity. As coagulation abnormalities are evident soon after trauma, their identification and subsequent treatment will help improve prognosis in these patients. This study aimed to assess the prevalence of coagulopathy in patients with varied severity of TBI. Complete blood count including
platelet count, Prothrombin time and Activated partial thromboplasin time were performed on one hundred patients admitted within 12hours of varied severity of head injury. Mild (GCS13-15;n=45), moderate (GCS 9-12;n=28) and severe (GCS 3-8;n=27). Based on the value of PT (11sec) and APTT (28sec) of laboratory controls, coagulopathy was defined as prolonged PT (>14sec) and/or APTT(>34sec). The prevalence of coagulopathy was 39%. In 30(76.9%) patients associated thrombocytopenia was present, while 18 patients had only thrombocytopenia. The prevalence of coagulopathy and thrombocytopenia increased with increasing severity of injury. Both were present in patients with mild injury also. A highly significant (p<0.001) association was seen between GCS and coagulopathy and thrombocytopenia. Measurement of hemostatic parameters in patients with head injury at admission irrespective of severity will help identify patients who will benefit with additional therapy.

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