Skip to main content

Main menu

  • Latest content
    • Latest content
  • Archive
  • About the journal
    • About the journal
    • Editorial board
    • Information for authors
    • FAQs
    • Thank you to our reviewers
    • The American Association for the Surgery of Trauma
  • Submit a paper
    • Online submission site
    • Information for authors
  • Email alerts
    • Email alerts
  • Help
    • Contact us
    • Feedback form
    • Reprints
    • Permissions
    • Advertising
  • BMJ Journals

User menu

  • Login

Search

  • Advanced search
  • BMJ Journals
  • Login
  • Facebook
  • Twitter
TSACO

Advanced Search

  • Latest content
    • Latest content
  • Archive
  • About the journal
    • About the journal
    • Editorial board
    • Information for authors
    • FAQs
    • Thank you to our reviewers
    • The American Association for the Surgery of Trauma
  • Submit a paper
    • Online submission site
    • Information for authors
  • Email alerts
    • Email alerts
  • Help
    • Contact us
    • Feedback form
    • Reprints
    • Permissions
    • Advertising
Open Access

Controversies and evidence gaps in the early management of severe traumatic brain injury: back to the ABCs

Seif Tarek El-Swaify, Mazen A Refaat, Sara H Ali, Abdelrahman E Mostafa Abdelrazek, Pavly Wagih Beshay, Menna Kamel, Bassem Bahaa, Abdelrahman Amir, Ahmed Kamel Basha
DOI: 10.1136/tsaco-2021-000859 Published 5 January 2022
Seif Tarek El-Swaify
1Department of surgery, Ain Shams University Hospital, Cairo, Egypt
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Seif Tarek El-Swaify
Mazen A Refaat
1Department of surgery, Ain Shams University Hospital, Cairo, Egypt
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Mazen A Refaat
Sara H Ali
1Department of surgery, Ain Shams University Hospital, Cairo, Egypt
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Abdelrahman E Mostafa Abdelrazek
1Department of surgery, Ain Shams University Hospital, Cairo, Egypt
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Pavly Wagih Beshay
1Department of surgery, Ain Shams University Hospital, Cairo, Egypt
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Menna Kamel
1Department of surgery, Ain Shams University Hospital, Cairo, Egypt
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Bassem Bahaa
1Department of surgery, Ain Shams University Hospital, Cairo, Egypt
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Abdelrahman Amir
1Department of surgery, Ain Shams University Hospital, Cairo, Egypt
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ahmed Kamel Basha
2Department of neurosurgery, Ain Shams University Faculty of Medicine, Cairo, Egypt
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Tables

  • Supplementary Materials
  • Additional Files
  • Table 1

    Risk factors for coagulopathy after traumatic brain injury

    CategoryRisk factors
    I. Patient characteristics
    • Age ≥75 years

    • Preinjury anticoagulant and/or antiplatelet therapy

    • ICU admission

    • Intravenous fluids resuscitation ≥2–3 L

    • Hemoglobin <12.4 mg/dL

    • Hypothermia (temperature <35°C)

    • Hypotension (SBP ≤90 mm Hg)

    • SI ≥1

    • Base excess ≤−6

    II. Injury characteristics
    • GCS ≤8 before intubation

    • Abnormal pupils (unilateral or bilateral unreactive)

    • Penetrating head trauma

    • AIShead ≥5

    • ISS ≥16

    • Midline shift on head CT

    • Cerebral edema on head CT

    • SAH on head CT

    • AIS, Abbreviated Injury Scale; GCS, Glasgow Coma Scale; ICU, intensive care unit; ISS, Injury Severity Score; SAH, subarachnoid hemorrhage; SBP, systolic blood pressure; SI, shock index (heart rate/systolic blood pressure).

  • Table 2

    Predictors of progressive hemorrhagic injury after traumatic brain injury

    CategoryPredictors
    I. Clinical
    • Older age

    • Lower admission GCS

    • Higher AIShead

    • Higher blood product requirement

    • Intraparenchymal brain contusions

    II. Initial conventional coagulation parameters
    • Lower platelet count (especially <100×109/L)

    • Lower functional fibrinogen (especially <356 mg/dL)

    • High INR (especially >1.2)

    • Lower factor VII activity (especially <77.5%)

    • Higher admission D-dimer levels

    • Higher fibrin monomers (especially ≥131.7 µg/mL)

    III. Initial viscoelastic measurements
    • Narrower median alpha angle (especially ≤65°)

    • Prolonged κ-time (especially ≥1.65 min)

    • Prolonged R-time (especially ≥5.65 min)

    • AIS, Abbreviated Injury Scale; GCS, Glasgow Coma Scale; INR, international normalized ratio; ISS, Injury Severity Score; R-time, reaction time; κ-time, kinetic time.

Supplementary Materials

  • Tables
  • Additional Files
  • Supplementary data

    [tsaco-2021-000859supp001.pdf]

  • Supplementary data

    [tsaco-2021-000859supp002.pdf]

Additional Files

  • Tables
  • Supplementary Materials
  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
    • Data supplement 2
PreviousNext
Back to top
Email

Thank you for your interest in spreading the word on TSACO.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Controversies and evidence gaps in the early management of severe traumatic brain injury: back to the ABCs
(Your Name) has sent you a message from TSACO
(Your Name) thought you would like to see the TSACO web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Controversies and evidence gaps in the early management of severe traumatic brain injury: back to the ABCs
Seif Tarek El-Swaify, Mazen A Refaat, Sara H Ali, Abdelrahman E Mostafa Abdelrazek, Pavly Wagih Beshay, Menna Kamel, Bassem Bahaa, Abdelrahman Amir, Ahmed Kamel Basha
Trauma Surg Acute Care Open Jan 2022, 7 (1) e000859; DOI: 10.1136/tsaco-2021-000859

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Cite This
  • APA
  • Chicago
  • Endnote
  • MLA
Loading
Controversies and evidence gaps in the early management of severe traumatic brain injury: back to the ABCs
Seif Tarek El-Swaify, Mazen A Refaat, Sara H Ali, Abdelrahman E Mostafa Abdelrazek, Pavly Wagih Beshay, Menna Kamel, Bassem Bahaa, Abdelrahman Amir, Ahmed Kamel Basha
Trauma Surg Acute Care Open Jan 2022, 7 (1) e000859; DOI: 10.1136/tsaco-2021-000859
Download PDF

Share
Controversies and evidence gaps in the early management of severe traumatic brain injury: back to the ABCs
Seif Tarek El-Swaify, Mazen A Refaat, Sara H Ali, Abdelrahman E Mostafa Abdelrazek, Pavly Wagih Beshay, Menna Kamel, Bassem Bahaa, Abdelrahman Amir, Ahmed Kamel Basha
Trauma Surgery & Acute Care Open Jan 2022, 7 (1) e000859; DOI: 10.1136/tsaco-2021-000859
Reddit logo Twitter logo Facebook logo Mendeley logo
Respond to this article
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Article
    • Abstract
    • Introduction
    • Prehospital transport
    • The airway and cervical spine
    • Breathing and ventilation
    • Circulation: optimizing cardiovascular physiology
    • Circulation: the optimal resuscitation fluid
    • Circulation: utility of blood products
    • Circulation: preinjury antithrombotics and their reversal
    • Circulation: is tranexamic acid the solution we need?
    • Difficult neurosurgical decisions
    • Limitations of this review
    • Conclusion
    • Ethics statements
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Measuring long-term outcomes after injury: current issues and future directions
  • Regulatory challenges in conducting human subjects research in emergency settings: the National Trauma Research Action Plan (NTRAP) scoping review
  • Trauma and syncope: looking beyond the injury
Show more Review

Similar Articles

 
 

CONTENT

  • Latest content
  • Archive
  • eLetters
  • Sign up for email alerts
  • RSS

JOURNAL

  • About the journal
  • Editorial board
  • Thank you to our reviewers
  • The American Association for the Surgery of Trauma

AUTHORS

  • Information for authors
  • Submit a paper
  • Track your article
  • Open Access at BMJ

HELP

  • Contact us
  • Reprints
  • Permissions
  • Advertising
  • Feedback form

©Copyright 2023 The American Association for the Surgery of Trauma