Coagulopathy as a surrogate of severity of injury in penetrating brain injury.

Penetrating brain injury (PBI) is the most devastating type of traumatic brain injury. Development of coagulopathy in the acute setting of PBI while common, remains of unclear significance as does its reversal. The aim of this study is to investigate the relationship between coagulopathy and clinical presentation, radiographic features, and outcome in civilian patients with PBI. Eighty-nine adult patients with PBI at a level I trauma center in Chicago who survived acute resuscitation and with available coagulation profile were analyzed. Coagulopathy was defined as INR > 1.3, platelet count 37 seconds. Median age (IQR) of our cohort was 27 (21-35) years, and 74 (83%) were male. The intent was assault in 74 cases (83%). The mechanism of PBI was gunshot wound in in all patients. Forty patients (45%) were coagulopathic at presentation. In a multiple regression model, coagulopathy was associated with lower Glasgow Coma Scale-motor score (GCS-M) (OR:0.67, CI: 0.48-0.94, p=0.02) and transfusion of blood products (OR: 3.91, CI:1.2-12.5, p=0.02). Effacement of basal cisterns was the only significant radiographic features associated with coagulopathy (OR:3.34, IC 1.08-10.37, p=0.04). Mortality was found to be significantly more common in coagulopathic patients (73% vs. 25%, p<0.001). However, in our limited sample, reversal of coagulopathy at 24 hours was not associated with a statistically significant improvement in outcome. The triad of coagulopathy, low post-resuscitation GCS, and radiographic effacement of basal cisterns, identifies a particularly ominous phenotype of PBI. The role, and potential reversal of, coagulopathy in this group warrants further investigation.