Clotting onset time may be a predictor of outcome in human brain injury: a pilot study.

In this study we assess the clotting onset time (COT) in samples from a population of traumatic brain injury patients. The patients were randomized to standard treatment plus high dose antithrombin (AT group) or standard treatment alone (nonAT group), during the first 16 hours after hospital admission. Our aim was to study the two patient groups during the first 5 days after injury, to assess COT as a coagulation monitoring method compared to routine parameters (thrombin-antithrombin complex (TAT), D-dimer, and soluble fibrin), and to correlate COT to clinical parameters and outcome. Clotting onset time measurements are carried out using free oscillating rheometry, where the endpoint of coagulation onset is determined by a deviation from initial viscoelastic properties of an oscillating sample. Both patient groups initially showed hypercoagulation. In the AT group, a significant increase of COT (i.e., decrease in hypercoagulation), was already seen 16 hours after hospital admission, but not until day 3 in the non AT group. Routine coagulation tests were not able to discriminate AT patients from nonAT patients. Clotting onset time correlated significantly to soluble fibrin, D-dimer, TAT, and leukocyte count. Additionally, COT levels at hospital admission correlated to outcomes measured with the Glasgow Outcome Scale (GOS) after 3 months. These results indicate that COT may be a clinically relevant variable with prognostic value, able to monitor the degree of hypercoagulation over time.

Outcome of traumatic brain injuries in 1,508 patients: impact of prehospital care.

This article describes the outcome of 1,508 patients with traumatic brain injuries (TBI) treated in a single neurosurgical unit over an 8-year period. Our aim has been to compare those outcomes with our previous results and with other large patient series. Another important goal was to evaluate the effect of the introduction of a 4-year ongoing study initiated in January 1993 using a new strategy of prehospital care on postresuscitation Glasgow Coma Score (GCS) and Glasgow Outcome Score (GOS). Results from the 1,508 patients showed good recovery or moderate disability in 69%, severe disability or vegetative state in 11%, and a mortality rate of 20%. When outcome of the most severely injured patients (GCS < or = 8) was compared with those of our previous and other large international patient series, more favorable outcome figures were shown in the present study. To evaluate the impact of the improved prehospital care after half of the study period, a logistic regression analysis showed after January 1993 a significantly increased expected odds/ratio for a postresuscitation GCS 8-15 rather than a GCS 3-4 (odds/ratio: 2.2; p < 0.001). For patients with postresuscitation GCS 5-7 and 8-15, the expected odds/ratio for a GOS 4-5 instead of GOS 1 increased significantly (odds/ratio: 2.2 and 1.7, respectively; p < 0.05-0.01). For patients with GCS 3-4, an increased expected odds/ratio (2.0; p < 0.05) for a GOS 2-3 rather than a GOS 1 was seen. The principal conclusion is that outcome for the severely injured patients in the present study is more favorable than in other large series of TBI. We posit that the introduction of effective prehospital care most likely contributed to the improved postresuscitation neurological status and consequently to the better outcome observed after January 1993.