# Rapid Thromboelastography Identifies Coagulopathy and Predicts Poor Outcomes in Severe Traumatic Brain Injury

## TL;DR

This study shows that rapid thromboelastography can detect blood clotting issues in severe traumatic brain injury patients and predict worse outcomes.

## Contribution

The study demonstrates that rapid thromboelastography is a useful tool for identifying coagulopathy and predicting mortality in severe TBI patients.

## Key findings

- Rapid thromboelastography (r-TEG) parameters significantly differ between coagulopathy groups in severe TBI patients.
- Patients with coagulopathy (hypercoagulable or hypocoagulable) had higher mortality rates compared to those with normal coagulation.
- r-TEG variables like R-time, K-time, alpha angle, and others were strong predictors of mortality in these patients.

## Abstract

Introduction

Traumatic brain injury (TBI) occurs when a force transmitted to the head or body results in neuropathologic damage and dysfunction. Approximately 25% of patients with TBI present with coagulopathy on admission, which is associated with increased mortality. Viscoelastic methods like rapid thromboelastography (r-TEG) and rotational thromboelastometry may be precise in identifying the coagulopathic changes in these patients. The objective of this study is to assess r-TEG in patients with severe TBI (sTBI).

Methods

This was a single-center cross-sectional study conducted in a 2059-bedded level 1 trauma center. Patients over 18 years of age who presented with sTBI [Glasgow Coma Scale (GCS), ≤8] with head injuries were included. All clinical and laboratory data were obtained from the charts. r-TEG was done according to the manufacturer’s protocol by a single operator. The coagulopathy was categorized as hypercoagulable, hypocoagulable, and normal based on r-TEG variables. Laboratory parameters and clinical outcomes were compared between the three groups.

Results

One hundred five patients with a median age of 33 years [interquartile range (IQR), 25-40 years] were included. The majority of patients (91%) were male. The commonest mechanism of injury was a road traffic accident (RTA) in 75% cases. The coagulopathy was hypercoagulable in six (6%), hypocoagulable in 38 (36%), and normal in 61 (58%) patients. The overall mortality rate was 36%. Among the r-TEG parameters, reaction (R) time, kinetic (K) time, alpha angle, maximum amplitude (MA), thrombodynamic potential index (TPI), time to maximum amplitude (TMA), shear elastic modulus (G), elasticity (E), and amplitude (A) were statistically significant between all groups. The age-adjusted multivariate analysis showed the following clinical and laboratory parameters as predictors of mortality: GCS, systolic blood pressure (SBP), blood sugar, aPTT, fibrinogen, R-time, K-time, alpha angle, and activated clotting time (ACT). The 57-day mortality among patients with hypocoagulable and hypercoagulable was higher than that of patients with normal coagulation status (log-rank test, p = 0.35)

Conclusion

r-TEG identifies coagulopathy in patients with sTBI. The mortality was higher in patients with coagulopathy than in those with a normal coagulation state.