Coagulopathy is commonly observed after traumatic brain injury (TBI). However, it is not known whether using the standard independent predictors in conjunction with coagulation tests would improve their prognostic value. We determined the incidence of TBI-associated coagulopathy in patients with isolated TBI (iTBI), evaluated the prognostic value of coagulation tests for in-hospital mortality, and tested their predictive power for in-hospital mortality in patients with iTBI. We conducted a retrospective, observational database study on 2319 consecutive patients with iTBI who attended the Huashan Hospital Department of the Neurosurgery Neurotrauma Center at Fudan University in China between December 2004 and June 2015. Two models based on the admission characteristics were developed: model A included predictors such as age, Glasgow Coma Scale (GCS) score, pupil reactivity, type of injury, and hemoglobin and glucose levels, while model B included the predictors from model A as well as coagulation test results. A total of 1643 patients enrolled between December 2004 and December 2011 were used to derive the prognostic models, and 676 patients enrolled between January 2012 and June 2015 were used to validate the models. Overall, 18.6% (n = 432) of the patients developed coagulopathy after iTBI. The prevalence of acute traumatic coagulopathy is associated with the severity of brain injury. The percentage of platelet count 1.25, the prothrombin time (PT) > 14 s, activated partial thromboplastin time (APTT) > 36 s, D-dimer >5 mg/L and fibrinogen (FIB) < 1.5 g/L was also closely related to the severity of brain injury, significance being found among three groups. Age, pupillary reactivity, GCS score, epidural hematoma (EDH), and glucose levels were independent prognostic factors for in-hospital mortality in model A, whereas age, pupillary reactivity, GCS score, EDH, glucose levels, INR >1.25, and APTT >36 s exhibited strong prognostic effects in model B. Discrimination and calibration were good for the development group in both prediction models. However, the external validation test showed that calibration was better in model B than in model A for patients from the validation population (Hosmer–Lemeshow test, p = 0.152 vs. p = 0.046, respectively). Coagulation tests can improve the predictive power of the standard model for in-hospital mortality after TBI.

Objective. Decompressive craniectomy (DC) is one of the most ardently debated topics in traumatic brain injury (TBI) treatment. The aim of this study is to compare the differences between DC with and without mass evacuation in patients with TBI. Methods. From January 2005 to December 2009, 164 patients underwent DC at our centre. Seventy-one of the 164 patients underwent DC for diffuse injury (group B). Ninety-three patients underwent DC as part of an operation to treat a mass lesion (group A). Patient characteristics and post-operative outcomes were compared between the two groups. Results. Thirty-six patients died during this study (22.0%). Fifty-nine of these patients (36.0%) remained either vegetative (n = 30) or severely disabled (n = 29). Sixty-nine patients (42%) had a Glasgow Outcome Scale (GOS) score of 4 to 5. Three predictors were significantly related to 60-day mortality: age older than 50 years (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.01–5.52), abnormal pupillary response to light (OR, 3.79; 95% CI, 1.29–11.14), and DC with mass evacuation (OR, 0.31; 95% CI, 0.12–0.79). Mortality differed substantially between patients with (group A) and without (group B) mass evacuation (14.0% versus 32.4%). Only one predictor was significantly related to good outcome: Glasgow Coma Scale (GCS) score at admission: (OR, 2.43; and 95% CI, 1.39–4.24). Conclusions. DC for patients with or without mass lesion has different patient characteristics. DC with mass evacuation has lower mortality than DC without mass evacuation. Outcome prediction following DC should be adjusted according to mass evacuation.

Traumatic brain injury (TBI) is frequently complicated by in-hospital events that contribute to prolonged hospitalization and poor neurological outcomes. T