The incidence and significance of hemostatic abnormalities in patients with head injuries

John D Olson, H. H. Kaufman, J. Moake, T. W. O'Gorman, K. Hoots, K. Wagner, C. Kice Brown, P. L. Gildenberg

Research output: Contribution to journalArticle

166 Citations (Scopus)

Abstract

Abnormal coagulation and fibrinolysis is a frequent complication in patients with head injury. This complication can be severe enough to lead to hemorrhage or thrombosis. A study was undertaken to determine if the hemostatic abnormalities are reliable indicators of outcome. Hemostasis in 269 patients with head injuries alone was screened using platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin clotting time (TCT), fibrinogen assay (FIB), level of fibrin-fibrinogen degradation products (FDP), and disseminated intravascular coagulation (DIC) score in the first 24 hours after injury. Test restults were compared with the outcome (discharged or dead) in the entire group and in subgroups divided on the basis of the severity of injury as determined by the Glasgow coma score (GCS). Increased consumptive coagulopathy at admission, as reflected in the DIC score, predicts the outcome of head-injured patients with a high degree of accuracy. The degree of increase of the initial FDP level and prolongation of TCT also correlated positively with the outcome. Prolongation of the APTT correlated strongly with unfavorable outcome in a large group of patients, and in a small group, markedly accelerated APTT also predicted death. Stepwise logistic regression analysis demonstrated that GCS, FDP level, and DIC score predicted outcome. Other tests did not provide additional predictive value. Abnormal hemostasis frequently complicates the course of patients with head injuries. This study demonstrates that hemostasis tests are predictors of outcome in these patients.

Original languageEnglish (US)
Pages (from-to)825-832
Number of pages8
JournalNeurosurgery
Volume24
Issue number6
StatePublished - 1989
Externally publishedYes

Fingerprint

Hemostatics
Craniocerebral Trauma
Partial Thromboplastin Time
Disseminated Intravascular Coagulation
Incidence
Hemostasis
Fibrinogen
Thrombin Time
Coma
Fibrin Fibrinogen Degradation Products
Prothrombin Time
Wounds and Injuries
Fibrinolysis
Platelet Count
Thrombosis
Logistic Models
Head
Regression Analysis
Hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Olson, J. D., Kaufman, H. H., Moake, J., O'Gorman, T. W., Hoots, K., Wagner, K., ... Gildenberg, P. L. (1989). The incidence and significance of hemostatic abnormalities in patients with head injuries. Neurosurgery, 24(6), 825-832.

The incidence and significance of hemostatic abnormalities in patients with head injuries. / Olson, John D; Kaufman, H. H.; Moake, J.; O'Gorman, T. W.; Hoots, K.; Wagner, K.; Kice Brown, C.; Gildenberg, P. L.

In: Neurosurgery, Vol. 24, No. 6, 1989, p. 825-832.

Research output: Contribution to journalArticle

Olson, JD, Kaufman, HH, Moake, J, O'Gorman, TW, Hoots, K, Wagner, K, Kice Brown, C & Gildenberg, PL 1989, 'The incidence and significance of hemostatic abnormalities in patients with head injuries', Neurosurgery, vol. 24, no. 6, pp. 825-832.
Olson JD, Kaufman HH, Moake J, O'Gorman TW, Hoots K, Wagner K et al. The incidence and significance of hemostatic abnormalities in patients with head injuries. Neurosurgery. 1989;24(6):825-832.
Olson, John D ; Kaufman, H. H. ; Moake, J. ; O'Gorman, T. W. ; Hoots, K. ; Wagner, K. ; Kice Brown, C. ; Gildenberg, P. L. / The incidence and significance of hemostatic abnormalities in patients with head injuries. In: Neurosurgery. 1989 ; Vol. 24, No. 6. pp. 825-832.
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