Coagulopathy as a Surrogate of Severity of Injury in Penetrating Brain Injury

J Neurotrauma. 2021 Jun 1;38(13):1821-1826. doi: 10.1089/neu.2020.7422. Epub 2021 Jan 20.


Penetrating brain injury (PBI) is the most devastating type of traumatic brain injury. Development of coagulopathy in the acute setting of PBI, though common, remains of unclear significance as does its reversal. The aim of this study is to investigate the relationship between coagulopathy and clinical presentation, radiographical features, and outcome in civilian patients with PBI. Eighty-nine adult patients with PBI at a Level I trauma center in Chicago, Illinois who survived acute resuscitation and with available coagulation profile were analyzed. Coagulopathy was defined as international normalized ratio [INR] >1.3, platelet count <100,000 /μL, or partial thromboplastin time >37 sec. Median age (interquartile range; IQR) of our cohort was 27 (21-35) years, and 74 (83%) were male. The intent was assault in 74 cases (83%). The mechanism of PBI was gunshot wound in all patients. Forty patients (45%) were coagulopathic at presentation. In a multiple regression model, coagulopathy was associated with lower Glasgow Coma Scale (GCS)-Motor score (odds ratio [OR], 0.67; confidence interval [CI], 0.48-0.94; p = 0.02) and transfusion of blood products (OR, 3.91; CI, 1.2-12.5; p = 0.02). Effacement of basal cisterns was the only significant radiographical features associated with coagulopathy (OR, 3.34; CI, 1.08-10.37; p = 0.04). Mortality was found to be significantly more common in coagulopathic patients (73% vs. 25%; p < 0.001). However, in our limited sample, reversal of coagulopathy at 24 h was not associated with a statistically significant improvement in outcome. The triad of coagulopathy, low post-resuscitation GCS, and radiographical effacement of basal cisterns identify a particularly ominous phenotype of PBI. The role, and potential reversal of, coagulopathy in this group warrants further investigation.

Keywords: coagulopathy; neurocritical care; penetrating brain injury.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Blood Coagulation Disorders / blood
  • Blood Coagulation Disorders / diagnostic imaging*
  • Blood Coagulation Disorders / epidemiology
  • Brain Injuries, Traumatic / blood
  • Brain Injuries, Traumatic / diagnostic imaging*
  • Brain Injuries, Traumatic / epidemiology
  • Cohort Studies
  • Female
  • Head Injuries, Penetrating / blood
  • Head Injuries, Penetrating / diagnostic imaging*
  • Head Injuries, Penetrating / epidemiology
  • Humans
  • Injury Severity Score*
  • Male
  • Prospective Studies
  • Retrospective Studies
  • Young Adult


  • Biomarkers