Association Between High-Level D-Dimer at Admission and Early Intubation in Patients With Moderate Traumatic Brain Injury

Abstract

It is unclear who can benefit from tracheal intubation in the moderate (mTBI) traumatic brain injury (TBI) population. Given that mTBI patients are conscious, intubation can cause intense stress, possibly triggering neurological deterioration. Therefore, identifying potential risk factors for intubation in mTBI patients can serve as a valuable clinical warning. We sought to investigate whether elevated D-dimer is a possible risk factor for intubation in mTBI patients. Using the STROBE statement, adult patients with isolated TBI (Glasgow Coma Scale [GCS] score 9-13) treated at a high-volume neurotrauma center between January 2015 and December 2020 were reviewed. The demographics, clinical presentation, neuroimaging, and laboratory information were collected based on the patients' electronic medical record. D-dimer values were assessed from serum when patients were admitted to the hospital. The primary study end-point was that the mTBI patient was intubated within 72 h upon admission. A total of 557 patients with mTBI were finally included in this study. Of these, 85 (15.3%) patients were intubated. Multi-variate logistic regression analysis showed that high-level D-dimer (≥17.9mg/L) was significantly associated with early tracheal intubation in mTBI patients (odds ratio, 3.10 [1.16-8.25]; p = 0.024) after adjusting for age, sex, GCS scores, Marshall scores, and Injury Severity Scores. Sensitivity analysis showed that high-level D-dimer had a robust correlation with intubation in the different subgroups or after propensity score matching. High-level D-dimer on admission is an independent risk factor for early tracheal intubation in isolated mTBI patients.

Keywords: D-dimer; endotracheal intubation; moderate traumatic brain injury; risk factor.

FIG. 1.

Flowchart that illustrates the selection process. Records of moderate traumatic brain injury patients enrolled in Tangdu Hospital from 2015 to 2020 with criteria of inclusion and exclusion. GCS, Glasgow Coma Scale; TBI, traumatic brain injury.

FIG. 2.

Subgroup analysis of the association between four distinct tiers of D-dimer levels and the occurrence of intubation in moderate traumatic brain injury, using level 1 as the baseline reference level. Each stratification was adjusted for age, sex, GCS, Marshall scores, and ISS. The interaction was not significant in the subgroup. Blue dots: odds ratio; blue lines: 95% confidence interval. 95% CI, 95% confidence interval; GCS, Glasgow Coma Scale; ISS, Injury Severity Score; MLS, midline shift; OR, odds ratio.