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Clinical Investigations

Coagulopathy in neuro trauma - a prospective analysis of the incidence and causes of coagulopathy in patients with pure neuro trauma and mixed trauma admitted to the National Hospital Sri Lanka

Authors:

DT Jayawickrama ,

Senior Registrar National Hospital of Sri Lanka, LK
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S Hapuarachchi

Consultant Anaesthetist, Neuro Surgical Unit, National Hospital, LK
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Abstract

Background: Coagulopathy is probably universal in patients with severe trauma. The pathogenesis of coagulopathy in trauma patients is complex. The precise cause is difficult to identify and is likely to be multifactorial. Clotting factor and platelet loss associated with vascular disruption as well as by intravascular consumption of clotting factors associated with massive endothelial damage are implicated in the coagulopathy in severe trauma patients. Coagulopathy in trauma patients is exacerbated by dilution, acidosis and hypothermia. Coagulopathy also occurs when brain or fat embolism leads to disseminated intravascular coagulation, hepatic injury leads to synthetic insufficiency or renal damage leads to uraemia and platelet dysfunction.

Method: During the study period 100 patients with moderate to severe trauma were admitted to the neuro surgical intensive care units (ICU) in National Hospital, Sri Lanka and were analysed in the study sample. The two groups were pure neuro trauma and mixed trauma (neuro trauma and other injuries).

A questionnaire was kept at the three neuro surgical ICUs at NHSL, to be attached to the notes of all the patients admitted to the neurosurgical ICU following trauma. These were filled by the ICU doctors as the results came in.

Results: During the study period 100 patients with moderate to severe trauma were admitted to the Neuro Surgical ICU in National Hospital, Sri Lanka and were analysed in the study sample. The two groups were pure neuro trauma and mixed trauma (neuro trauma and other injuries).

For the purpose of the study each patient was assessed for the 1st 24 hours in the Neuro Surgical ICU. Coagulopathy was taken as positive if INR > 1.5 or platelet count < 100,000. Acidosis was taken as pH < 7.35 and hypothermia was taken as temperature less than 34 0C. Deranged renal and liver function test was considered as dysfunction.

Activated partial thromboplastin time (APTT) was not an available test in the NHSL laboratory.

Conclusion: Results from this audit did not show a significant difference between the coagulopathy associated with pure neuro trauma and mixed trauma. A slight increase in trend in coagulopathy was seen in pure neuro trauma group compared with mixed trauma.

There was no significant difference between the presence of a particular factor favoring coagulopathy and the presence of coagulopathy in the two study groups. The coagulopathy in the above two groups is likely to be multi factorial.

Key words: neurotrauma; coagulopathy

DOI: 10.4038/slja.v19i1.2855

Sri Lankan Journal of Anaesthesiology Vol.19(1) 2011 pp.26-32

Keywords: neurotrauma coagulopathy 
DOI: http://doi.org/10.4038/slja.v19i1.2855
How to Cite: Jayawickrama, D. & Hapuarachchi, S., (2011). Coagulopathy in neuro trauma - a prospective analysis of the incidence and causes of coagulopathy in patients with pure neuro trauma and mixed trauma admitted to the National Hospital Sri Lanka. Sri Lankan Journal of Anaesthesiology. 19(1), pp.26–32. DOI: http://doi.org/10.4038/slja.v19i1.2855
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Published on 14 Mar 2011.
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