COAGULOPATHY IN ACUTE HEAD-INJURY - A STUDY OF ITS ROLE AS A PROGNOSTIC INDICATOR

The aim of this investigation was to determine the prognostic value of coagulation abnormalities in a defined subset of patients with acute head injury. Prothrombin time, accelerated partial thromboplastin time (APTT), thrombin clotting time, fibrinogen assay, platelet count, fib rin degradation products (FDP) were assayed in 204 patients with acute closed head injury. Their values were graded on a score 0-3 and the s um score for each patient regarded as the disseminated intravascular c oagulation (DIG) score. Moderate to severe DIC scores were evident in 38% of the cohort. At least one parameter was abnormal in 71% of patie nts. The DIC score correlated inversely with the Glasgow coma score (G CS) (p<0.0001). In the GCS 13-15 subset, FDP scores were significant p redictors of poor outcome (p<0.001). In the GCS 6-12 subset, the APTT score (p<0.001), and DIC score (p<0.0001) predicted an adverse outcome . The DIC scores were significantly abnormal in most patients who had a poor outcome, without evidence of adverse predictors on CT. Logistic regression analysis confirmed the independent predictive capacity of APTT, FDP and DIC scores when values for GCS were fixed. Abnormal haem ostatic parameters may enhance the predictive ability in subsets of pa tients with acute head injury defined by clinical or CT predictors.