Abstract
Objective: Patients with traumatic head injury may develop rapidly progressive disturbance of consciousness after some time even though they can speak reasonably well on admission. This condition is called “talk and deteriorate (T&D)” and it has a poor prognosis. It is also difficult to forecast the occurrence of T&D on initial examination of patients with head injury. Therefore, to find prognostic predictors of T&D, we investigated clinical features and coagulation-fibrinolysis markers (focusing on the changes of D-dimer) in the hyperacute phase after head injury.
Patients: Among patients presenting to the Emergency and Critical Care Center of Kawaguchi Municipal Medical Center (Saitama, Japan) between April 2007 and September 2013 with isolated traumatic head injury of grade 3 or higher according to the Abbreviated Injury Score (AIS), we assessed 98 patients who were grade 13 or higher on the Glasgow Coma Scale (GCS) at admission and in whom blood clotting parameters were measured within 1 hour after injury.
Methods: (1) The patients with T&D (T&D group) and those without T&D (non-T&D group) were compared with regard to age, sex, GCS, AIS, and coagulation-fibrinolysis markers. (2) Multiple logistic regression analysis was performed to identify prognostic predictors of T&D. (3) Coagulation-fibrinolysis markers were measured on admission and at 3, 6, and 12 hours after injury, and changes over time were compared between the T&D group and non-T&D group.
Results: (1) The AIS (p=0.001), as well as the levels of fibrin degradation products and D-dimer (both p<0.001) among coagulation-fibrinolysis parameters, were significantly higher in the T&D group. (2) The AIS (p=0.02) and the D-dimer level (p<0.001) were independent prognostic predictors of T&D, with the cut-off values being grade 5 for the AIS and 37.5 µg/mL for D-dimer. (3) The T&D group showed significantly higher D-dimer levels at all times of assessment (p<0.01).
Conclusion: Measurement of D-dimer is useful for forecasting T&D in the hyperacute phase of head injury.
