Fibrinolytic markers and neurologic outcome in traumatic brain injury

Aims: To determine the usefulness of fibrinolytic markers as early prognostic indicators in patients with isolated head trauma.
Materials and Methods: Sixty-two consecutive patients (26 women and 36 men; mean age 61 years, range 2-76 years) with isolated head trauma seen within the first three hours of the trauma were included in the study. The Glasgow Coma score (GCS), platelet counts (Plt), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products (FDP) and D-dimer levels were measured. Head computerized tomography (CT) findings were categorized as brain edema, linear fracture, depressed fracture, contusion and bleeding. Plt counts, PT, PTT, fibrinogen, FDP, D-dimer levels and CT findings were compared with both GCS and mortality in the first week. Statistical significance was accepted at P£0.05.
Results: A marked negative relationship was found between GCS and PT, PTT, FDP and D-dimer levels ( P < 0.001). Plt levels did not correlate with GCS. Mortality was most strongly related to GCS, PT, FDP and D-dimer levels ( P < 0.001, P < 0.001, P < 0.001 and P < 0.001, respectively). We found no relationship between mortality and CT findings, nor was there any significant relationship between Plt, PTT and fibrinogen levels.
Conclusion: GCS and fibrinolytic markers measured within the first three hours were useful in determining the prognosis of patients with isolated head trauma.

Keywords
Disseminated intravascular coagulopathy, fibrinogen, Glasgow Coma score, prognosis, traumatic brain injury