Correlation of D-Dimer level with outcome in traumatic brain injury
Abstract
Introduction: Traumatic brain injury (TBI) is a common neurosurgical emergency and a common public health problem with high mortality and long term morbidity. The cost incurred by TBI is immense. The major determinant of outcome following TBI is the severity of the primary injury. However, secondary injuries including coagulopathy are treatable prognostic factors. Many studies have revealed that coagulopathy of trauma depicted by increasing level of D-dimer is associated with poor prognosis in TBI. So, early dectection and correction of such abnormality is very important in management of TBI.Methods: This is a prospective observational study conducted at Department of Surgery TUTH (Tribhuvan University Teaching Hospital), Kathmandu,Nepal over a period of one year. One hundred and forty eight patients of TBI were included in the study. Clinical profile of the patients and D-dimer level were monitored during the hospital course. D-dimer level was correlated with outcome variables including duration of hospital stay, duration of Intensive care unit (ICU) stay and Glasgow outcome scale (GOS).Results: A total of 194 patients were admitted with the diagnosis of traumatic brain injury during the study period and out of them 148 patients were enrolled for the study. Out of 148 patients one hundred and twenty (81.1%) were males and twenty eight (18.9%) were females. The mean age was 29.71±18.07 and the age ranged from 1 to 78 years. Seventy (47.3%) patient were between 21 to 40 years of age. The mean duration of hospital stay was 9.83±13.58 days and the mean duration of ICU stay was 3.78±7.06 days. Contusion was the most common lesion in our patients. Of the patients studied 111 patients (75%) had good recovery with GOS of 5, 9 patients (6.1%) had GOS of 4, 6 patients (4.1%) had GOS of 3, 1 patients (0.7%) had GOS of 2 and 21 patients (14.1%) had GOS of 1. Normal D-dimer was seen in 102 patients (68.9%) and elevated D-dimer in 46 patients (31.1%). Man –Whitney test shows higher D-dimer levels positively correlated with duration of hospital stay, duration of ICU stay and Glasgow Outcome Scale. Pearson chi-square test revealed higher levels of D-dimer correlated with grade of injury but not with mode of injury.Conclusion: D-dimer is elevated in significant proportion of patients with TBI and abnormal D-dimer level is associated with poor outcome in TBI.References
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22.Parmar KA, Rao S, Abu-zidan FM. Head injuries in warfarinised patients. Singapore Med J 2006;47(8):676-8.
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29.Dharkar SR, Bhargava N. Bilateral epidural hematoma. Acta neuochir(wein) 1991;110:29-32.
30.Poon WS, Rehaman SU, Poon CYF. Traumatic extra dual hematoma of delayed onset is not a rarity. Neurosurgery 1992;30:681-686.
31.Alliez JR, Hilal N, Kaya JM. Epidural intracranial hematomas: practical issues revealed by management of 100 recent cases. Neurochirurgie 2005;51(5):464-70.
32Wiberger JE. Harris M. Diamond DL. Acute subdural hematoma: morbidity, mortality and operative timings. J Neurosurg 1991;74:212-218.
33.Poirier MP. Concussions: Assessment, management and recommendations for return to activity. Clinical Pediatric Emergency Medicine 4(3):179-185.
34.Townsend CM. Townsend: Sabiston Textbook of Surgery. 18th ed. Saunders 2007, p2256-2257.
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36.White RJ, Likavec MJ. The diagnosis and initial management of head injury. N Engl J Med 1992;327:1507-1511
37. Smith DH, Meaney DF, Shull Wh. Diffuse axonal injury in head trauma. J Head Trauma Rehabil 2003 ; 18(4):307-16
38.Gennarelli TA, Thibault LE, Adams JH, et al. Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 1982;12(6):564-74.
39.Adams JH. Pathology of non missile head injury. Neuroimaging clin N Amer 1991;(1):3974-3981.
40. Marmarou A, Signoretti S Fatouros PP, Portella G, Aygok GA, Bullock MR. Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. J Neurosurg 2006;104:720-30.
41.Bayir A et al. Fibrinolytic markers and neurologic outcome in traumatic brain injury. Neurology India 2006:54:4
42. Saggar V et al. Hemostatic abnormalities in patients with closed head injuries and their role in predicting early mortality. Journal of Neurotrauma 26:1665–1668
43. Harhangi et al. Coagulation disorders after traumatic brain injury. Acta Neurichir (Wien) 2008 150: 165-175
44. Halpren CH et al. Traumatic coagulopathy : the effect of brain injury. Journal of neurotrauma 25:997-1001
45. D-dimer.From Wikipedia, the free encyclopedia.
46. Swanson CA et al. Low plasma D-dimer concentration predicts the absence of traumatic brain injury in children. J Trauma. 2010 May;68(5):1072-7.
47. Tian HL et al. D-dimer as a predictor of progressive hemorrhagic injury in patients with traumatic brain injury : analysis of 194 cases. Neurosurg Rev.2010 Jul;33(3): 359-65.
48. Tesdale G, Jennett B. Assesment of coma and impaired consciousness. A practical scale. Lancet 1974, 2:81-84.
49. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1:480-484.
50. Mushkudiani NA et al. Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007;259-269.
51.Alissa A. Radiological findings in patients who attended the emergency department with head injury. The Middle East Journal of Emergency Medicine 2003;3(1).
52.Thiruppathy SP, Muthukumar, N. Mild head injury: revisited. Acta Neurochirugica 2004;146(10):1075-1083.
53. Iskhakov OS, Shipilevskii VM, Aliab’ev VN, Shipuleva IV. Clinical and computed tomographic comparisons of analysis of the condition in children with brain injury of 13-15 scores by the Glasgow Coma Scale on admission to hospital. Zh Vopr Neirokhir Im N N Burdenko. 2005;(3):8-13.
54. Naseri M, Tomasian A, Moghaddas AR. Correlation of ct scan findings with the level of consciousness in acute head rauma. Iran. J. Radiol 2005,2:3-4.
55. Gomez PA et al (1996) Mild head injury :differences in prognosis among patients with aGlasgow Coma Scale score of 13 to 15 and analysis of factors associated with abnormal CT ?ndings. Br J Neurosurg 10(5):453–46
2. Niedzwecki CM, Marwitz JH, Ketchum JM, et al. Traumatic brain injury: a comparison of inpatient functional outcomes between children and adults. J Head Trauma Rehabil. Jul-Aug 2008;23(4):209-19
3. Dawodu S T. Traumatic Brain Injury (TBI) - Definition, Epidemiology, Pathophysiology; Emedicine. Available at: http://www.emedicine.medscape.com, Updated: Jun 13, 2011.
4.Hagga JR, Lanzieri CF, Sartoris DJ, Zerhouni EA. CT & MRI of the whole body. 4th ed. St Louis: Mosby, 2003:317-350.
5. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.
6. Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Atlanta (GA): Centers for Disease Control and Prevention; 2003.
7.Finkelstein E, Corso P, Miller T and associates. The Incidence and Economic Burden of Injuries in the United States. New York (NY): Oxford University Press; 2006.
8. Jennett B. Epidemiology of head injury. J Neurol Neurosurg Psychiatry. Apr 1996;60(4):362-9.
9. Wrightson P, Gronwall D. Mild head injury in New Zealand: incidence of injury and persisting symptoms. N Z Med J. Mar 27 1998;111(1062):99-101.
10.Wang CC, Schoenberg BS, Li SC, Yang YC, Cheng XM & Bolis CL. Brain injury due to head trauma. Epidemiology in urban areas of the People’s Republic of China. Archieves of Neurology 1986;43:570-572.
11.Helmy A et al. Traumatic brain injury: intensive care management. Br J Anaesth 2007;99:32-42.
12.Oslon DA. Head injury ; emedicine. Available at http://www.emedicine.medscape.com, Updated: Jul 20 , 2011
13.Ghimire P. Head injury management in the western regional hospital, Pokhara, Nepal. VI International surgical Conference 2002:21-23 Nov, Society of Surgeons of Nepal.
14.Timilsina DS. General Surgeons in the management of head injury. JSSN 2005;8:3-10.
15.Shepard S. Head Trauma J Neuroscience 2004;20(8):2825-2834.
16.Youmans J. Neurological Surgery. 5th ed. Philadelphia: WB Saunders, 2004:5019-5273.
17.Chesnut RM et al Early indicators of prognosis in severe traumatic brain injury. Brain Trauma Foundation website.
Available at: https://www.braintrauma.org/pdf/protected/proognosis_guidelines.pdf. Accessed March 18, 2010.
18. J.-R Kuo et al. Correlation of a high D-dimer level with poor outcome in traumatic intracranial hemorrhage. European Journal of Neurology 2007,14 ; 1073-1078.
19.Bondanelli M, Ambrosio AR. Hypopituitarism after traumatic brain injury. Europ J Endocrin 2005; 152(5):679-691
20. Klein MJ. Post head injury endocrine complications; Emedicine. Available at: http://www.emedicine.medscape.com, Updated: Jan 5, 2009.
21. Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res. 2002;24(1):24-8.
22.Parmar KA, Rao S, Abu-zidan FM. Head injuries in warfarinised patients. Singapore Med J 2006;47(8):676-8.
23.Smith C et al. Association of APO-E4 and cerebrovascular pathology in traumatic brain injury. J Neurol Neurosurg 2004;12:34-37
24.Poirire MP. Concussions: Assessment, management, and recommendations for return to activity. Clinical Pediatric Emergency Medicine 4(3):179-185.
25Toyama Y, Kobayashi T, Nishiyama Y, Satoh K, Ohkawa M, Seki K. CT for acute stage of closed head injury. Radiat med 2005;(5):309-16.
26Gentry LR. Head trauma SW Atlas: MRI of brain and spine. New York, Raven press; 1991:p439-456.
27.Osborn AG. Diagnostic neuroradiology. Mosby-yearbook. St Louis: Mosby, 1994:199-244.
28.Macpherson BCM, Macpherson P, Jennett B. CT incidence of intracranial contusion and hematoma in relation to presence and type of skull frature. Clin Radiology 1990;42:321-326.
29.Dharkar SR, Bhargava N. Bilateral epidural hematoma. Acta neuochir(wein) 1991;110:29-32.
30.Poon WS, Rehaman SU, Poon CYF. Traumatic extra dual hematoma of delayed onset is not a rarity. Neurosurgery 1992;30:681-686.
31.Alliez JR, Hilal N, Kaya JM. Epidural intracranial hematomas: practical issues revealed by management of 100 recent cases. Neurochirurgie 2005;51(5):464-70.
32Wiberger JE. Harris M. Diamond DL. Acute subdural hematoma: morbidity, mortality and operative timings. J Neurosurg 1991;74:212-218.
33.Poirier MP. Concussions: Assessment, management and recommendations for return to activity. Clinical Pediatric Emergency Medicine 4(3):179-185.
34.Townsend CM. Townsend: Sabiston Textbook of Surgery. 18th ed. Saunders 2007, p2256-2257.
35.Servadei F, Murray GD, Teasdale GM, Dearden M, lannotti F, Lapierre F et al. Traumatic subarachnoid hemorrhage: hemographic and clinical study of 750 patients from the European brain injury consortium survey of head injuries. Neurosurgery 2002;50(2):261-267.
36.White RJ, Likavec MJ. The diagnosis and initial management of head injury. N Engl J Med 1992;327:1507-1511
37. Smith DH, Meaney DF, Shull Wh. Diffuse axonal injury in head trauma. J Head Trauma Rehabil 2003 ; 18(4):307-16
38.Gennarelli TA, Thibault LE, Adams JH, et al. Diffuse axonal injury and traumatic coma in the primate. Ann Neurol 1982;12(6):564-74.
39.Adams JH. Pathology of non missile head injury. Neuroimaging clin N Amer 1991;(1):3974-3981.
40. Marmarou A, Signoretti S Fatouros PP, Portella G, Aygok GA, Bullock MR. Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. J Neurosurg 2006;104:720-30.
41.Bayir A et al. Fibrinolytic markers and neurologic outcome in traumatic brain injury. Neurology India 2006:54:4
42. Saggar V et al. Hemostatic abnormalities in patients with closed head injuries and their role in predicting early mortality. Journal of Neurotrauma 26:1665–1668
43. Harhangi et al. Coagulation disorders after traumatic brain injury. Acta Neurichir (Wien) 2008 150: 165-175
44. Halpren CH et al. Traumatic coagulopathy : the effect of brain injury. Journal of neurotrauma 25:997-1001
45. D-dimer.From Wikipedia, the free encyclopedia.
46. Swanson CA et al. Low plasma D-dimer concentration predicts the absence of traumatic brain injury in children. J Trauma. 2010 May;68(5):1072-7.
47. Tian HL et al. D-dimer as a predictor of progressive hemorrhagic injury in patients with traumatic brain injury : analysis of 194 cases. Neurosurg Rev.2010 Jul;33(3): 359-65.
48. Tesdale G, Jennett B. Assesment of coma and impaired consciousness. A practical scale. Lancet 1974, 2:81-84.
49. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1:480-484.
50. Mushkudiani NA et al. Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007;259-269.
51.Alissa A. Radiological findings in patients who attended the emergency department with head injury. The Middle East Journal of Emergency Medicine 2003;3(1).
52.Thiruppathy SP, Muthukumar, N. Mild head injury: revisited. Acta Neurochirugica 2004;146(10):1075-1083.
53. Iskhakov OS, Shipilevskii VM, Aliab’ev VN, Shipuleva IV. Clinical and computed tomographic comparisons of analysis of the condition in children with brain injury of 13-15 scores by the Glasgow Coma Scale on admission to hospital. Zh Vopr Neirokhir Im N N Burdenko. 2005;(3):8-13.
54. Naseri M, Tomasian A, Moghaddas AR. Correlation of ct scan findings with the level of consciousness in acute head rauma. Iran. J. Radiol 2005,2:3-4.
55. Gomez PA et al (1996) Mild head injury :differences in prognosis among patients with aGlasgow Coma Scale score of 13 to 15 and analysis of factors associated with abnormal CT ?ndings. Br J Neurosurg 10(5):453–46
Published
2016-03-05
How to Cite
SUBEDI, Pradip Prasad.
Correlation of D-Dimer level with outcome in traumatic brain injury.
J Soc Surg Nep, [S.l.], v. 17, n. 1, mar. 2016.
ISSN 2392-4772.
Available at: <https://www.jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=DOI%3A%20http%3A%2F%2Fdx.doi.org%2F10.3126%2Fjssn.v17i1.15177>. Date accessed: 02 may 2024.
Issue
Section
Original Article
Keywords
GOS (Glasgow outcome scale), Traumatic Brain injury, D-dimer
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