[Disturbance of the coagulatory system in patients with head injury in acute phase]

Abstract

The coagulation and fibrinolytic function of 100 cases (male 75, female 25) of trauma limited to the head was evaluated in acute phase. The coagulation and fibrinolytic function was evaluated by 6 parameters, consisting of platelet counts, PT, APTT, fibrinogen, serum FDP, and protamine sulfate test. Head injury was categorized into 5 groups according to CT findings: subdural hematoma (SDH: 13 cases), cerebral contusion (CC: 46 cases), epidural hematoma (EDH: 21 cases), skull fracture only (Fr: 14 cases), and cerebral concussion (Co: 6 cases). The results were as follows, in 19 dead cases, severe coagulopathy was observed. In intracerebral injury group (SDH + CC), serum FDP level was markedly elevated. The incidence of disseminated intravascular coagulation (DIC) following head injury was 24% (in dead cases 73.7% in survival cases 12.3%) of all cases, and mortality of cases with DIC was exceedingly high (58.3%). In 14 dead cases with DIC, the patients did not recover from DIC, and their mean survival time was only 89.2 hours. In 10 survival cases with DIC, the patients recovered from DIC. APTT was the most important to estimate the mortality of head injury. Thus, the evaluation of coagulation and fibrinolytic function in head injury in acute phase is not only important to know the occurrence of DIC, but also useful to predict the severity and prognosis of head injury.