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001-es BibID:BIBFORM107428
035-os BibID:(scopus)85130632463 (wos)000730887100003
Első szerző:Böhm, Julia K.
Cím:Extended Coagulation Profiling in Isolated Traumatic Brain Injury : a CENTER-TBI Analysis / Böhm Julia K., Schaeben Victoria, Schäfer Nadine, Güting Helge, Lefering Rolf, Thorn Sophie, Schöchl Herbert, Zipperle Johannes, Grottke Oliver, Rossaint Rolf, Stanworth Simon, Curry Nicola, Maegele Marc, CENTER-TBI Participants and Investigators
Dátum:2021
ISSN:1541-6933
Megjegyzések:Abstract Background: Trauma-induced coagulopathy in traumatic brain injury (TBI) remains associated with high rates of complications, unfavorable outcomes, and mortality. The underlying mechanisms are largely unknown. Embedded in the prospective multinational Collaborative European Neurotrauma Efectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, coagulation profles beyond standard conventional coagulation assays were assessed in patients with isolated TBI within the very early hours of injury. Methods: Results from blood samples (citrate/EDTA) obtained on hospital admission were matched with clinical and routine laboratory data of patients with TBI captured in the CENTER-TBI central database. To minimize confound ing factors, patients with strictly isolated TBI (iTBI) (n=88) were selected and stratifed for coagulopathy by routine international normalized ratio (INR): (1) INR<1.2 and (2) INR?1.2. An INR>1.2 has been well adopted over time as a threshold to defne trauma-related coagulopathy in general trauma populations. The following parameters were evaluated: quick's value, activated partial thromboplastin time, fbrinogen, thrombin time, antithrombin, coagulation factor activity of factors V, VIII, IX, and XIII, protein C and S, plasminogen, D-dimer, fbrinolysis-regulating parameters (thrombin activatable fbrinolysis inhibitor, plasminogen activator inhibitor 1, antiplasmin), thrombin generation, and fbrin monomers. Results: Patients with iTBI with INR?1.2 (n=16) had a high incidence of progressive intracranial hemorrhage associ ated with increased mortality and unfavorable outcome compared with patients with INR<1.2 (n=72). Activity of coagulation factors V, VIII, IX, and XIII dropped on average by 15?20% between the groups whereas protein C and S levels dropped by 20%. With an elevated INR, thrombin generation decreased, as refected by lower peak height and endogenous thrombin potential (ETP), whereas the amount of fbrin monomers increased. Plasminogen activity signifcantly decreased from 89% in patients with INR<1.2 to 76% in patients with INR?1.2. Moreover, D-dimer levels signifcantly increased from a mean of 943 mg/L in patients with INR<1.2 to 1,301 mg/L in patients with INR?1.2
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
CENTER-TBI
Coagulopathy
Fibrin monomers
Progressive intracranial hemorrhage
Thrombin generation
Traumatic brain injur
Megjelenés:Neurocritical Care. - 36 : 3 (2021), p. 927-941. -
További szerzők:Schaeben, Victoria Schäfer, Nadine Güting, Helge Lefering, Rolf Thorn, Sophie Schöchl, Herbert Zipperle, Johannes Grottke, Oliver Rossaint, Rolf Stanworth, Simon Curry, Nicola Maegele, Marc Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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2.

001-es BibID:BIBFORM104821
035-os BibID:(WOS)000598107300001 (Scopus)85109945359
Első szerző:Böhm, Julia K.
Cím:Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI) : a CENTER-TBI Analysis / Julia K. Böhm1, Helge Güting, Sophie Thorn, Nadine Schäfer, Victoria Rambach, Herbert Schöchl, Oliver Grottke, Rolf Rossaint, Simon Stanworth, Nicola Curry, Rolf Lefering, Marc Maegele, CENTERTBI Participants and Investigators
Dátum:2020
ISSN:1541-6933
Megjegyzések:Abstract Background: Trauma-induced coagulopathy in patients with traumatic brain injury (TBI) is associated with high rates of complications, unfavourable outcomes and mortality. The mechanism of the development of TBI-associated coagulopathy is poorly understood. Methods: This analysis, embedded in the prospective, multi-centred,observational Collaborative European Neuro Trauma Efectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, aimed to characterise the coagulopathy of TBI. Emphasis was placed on the acute phase following TBI, primary on subgroups of patients with abnormal coagula tion profle within 4 h of admission, and the impact of pre-injury anticoagulant and/or antiplatelet therapy. In order to minimise confounding factors, patients with isolated TBI (iTBI) (n=598) were selected for this analysis. Results: Haemostatic disorders were observed in approximately 20% of iTBI patients. In a subgroup analysis, patients with pre-injury anticoagulant and/or antiplatelet therapy had a twice exacerbated coagulation profle as likely as those without premedication. This was in turn associated with increased rates of mortality and unfavourable outcome post-injury. A multivariate analysis of iTBI patients without pre-injury anticoagulant therapy identifed several inde pendent risk factors for coagulopathy which were present at hospital admission. Glasgow Coma Scale (GCS) less than or equal to 8, base excess (BE) less than or equal to ?6, hypothermia and hypotension increased risk signifcantly. Conclusion: Consideration of these factors enables early prediction and risk stratifcation of acute coagulopathy after TBI, thus guiding clinical management.
Tárgyszavak:Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
CENTER-TBI
Traumatic brain injury
Coagulopathy
Risk factors
Megjelenés:Neurocritical Care. - 35 : 1 (2020), p. 184-196. -
További szerzők:Güting, Helge Thorn, Sophie Schäfer, Nadine Rambach, Victoria Schöchl, Herbert Grottke, Oliver Rossaint, Rolf Stanworth, Simon Curry, Nicola Lefering, Rolf Maegele, Marc Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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3.

001-es BibID:BIBFORM107422
035-os BibID:(cikkazonosító)e1003761 (scopus)85114922058 (wos)000724338300003
Első szerző:Lecky, Fiona
Cím:The burden of traumatic brain injury from low-energy falls among patients from 18 countries in the CENTER-TBI Registry : a comparative cohort study / Lecky Fiona E., Otesile Olubukola, Marincowitz Carl, Majdan Marek, Nieboer Daan, Lingsma Hester F., Maegele Marc, Citerio Giuseppe, Stocchetti Nino, Steyerberg Ewout W., Menon David K., Maas Andrew I. R., CENTER-TBI Participants and Investigators
Dátum:2021
ISSN:1549-1676
Megjegyzések:Background Traumatic brain injury (TBI) is an important global public health burden, where those injured by high-energy transfer (e.g., road traffic collisions) are assumed to have more severe injury and are prioritised by emergency medical service trauma triage tools. However recent studies suggest an increasing TBI disease burden in older people injured through low-energy falls. We aimed to assess the prevalence of low-energy falls among patients presenting to hospital with TBI, and to compare their characteristics, care pathways, and outcomes to TBI caused by high-energy trauma. Methods and findings We conducted a comparative cohort study utilising the CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) Registry, which recorded patient demographics, injury, care pathway, and acute care outcome data in 56 acute trauma receiving hospitals across 18 countries (17 countries in Europe and Israel). Patients presenting with TBI and indications for computed tomography (CT) brain scan between 2014 to 2018 were purposively sampled. The main study outcomes were (i) the prevalence of low-energy falls causing TBI within the overall cohort and (ii) comparisons of TBI patients injured by low-energy falls to TBI patients injured by high-energy transfer?in terms of demographic and injury characteristics, care pathways, and hospital mortality. In total, 22,782 eligible patients were enrolled, and study outcomes were analysed for 21,681 TBI patients with known injury mechanism; 40% (95% CI 39% to 41%) (8,622/21,681) of patients with TBI were injured by low-energy falls. Compared to 13,059 patients injured by high-energy transfer (HE cohort), the those injured through low-energy falls (LE cohort) were older (LE cohort, median 74 [IQR 56 to 84] years, versus HE cohort, median 42 [IQR 25 to 60] years; p < 0.001), more often female (LE cohort, 50% [95% CI 48% to 51%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001), more frequently taking pre-injury anticoagulants or/and platelet aggregation inhibitors (LE cohort, 44% [95% CI 42% to 45%], versus HE cohort, 13% [95% CI 11% to 14%]; p < 0.001), and less often presenting with moderately or severely impaired conscious level (LE cohort, 7.8% [95% CI 5.6% to 9.8%], versus HE cohort, 10% [95% CI 8.7% to 12%]; p < 0.001), but had similar in-hospital mortality (LE cohort, 6.3% [95% CI 4.2% to 8.3%], versus HE cohort, 7.0% [95% CI 5.3% to 8.6%]; p = 0.83). The CT brain scan traumatic abnormality rate was 3% lower in the LE cohort (LE cohort, 29% [95% CI 27% to 31%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001); individuals in the LE cohort were 50% less likely to receive critical care (LE cohort, 12% [95% CI 9.5% to 13%], versus HE cohort, 24% [95% CI 23% to 26%]; p < 0.001) or emergency interventions (LE cohort, 7.5% [95% CI 5.4% to 9.5%], versus HE cohort, 13% [95% CI 12% to 15%]; p < 0.001) than patients injured by high-energy transfer. The purposive sampling strategy and censorship of patient outcomes beyond hospital discharge are the main study limitations. Conclusions We observed that patients sustaining TBI from low-energy falls are an important component of the TBI disease burden and a distinct demographic cohort; further, our findings suggest that energy transfer may not predict intracranial injury or acute care mortality in patients with TBI presenting to hospital. This suggests that factors beyond energy transfer level may be more relevant to prehospital and emergency department TBI triage in older people. A specific focus to improve prevention and care for patients sustaining TBI from low-energy falls is required.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
traumatic brain injury
Megjelenés:PLOS Medicine. - 18 : 9 (2021), p. 1-22. -
További szerzők:Otesile, Olubukola Marincowitz, Carl Majdan, Marek Nieboer, Daan Lingsma, Hester Maegele, Marc Citerio, Giuseppe Stocchetti, Nino Steyerberg, Ewout W. Menon, David Krishna Maas, Andrew I. R. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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