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

Article Figures & Data

Table 1

Risk factors for coagulopathy after traumatic brain injury

Category	Risk 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 AIS_head ≥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

Category	Predictors
I. Clinical	Older age Lower admission GCS Higher AIS_head 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.