Introduction

Traumatic brain injury (TBI) is a major cause of death and disability. Fibrinogen can be significantly depleted following severe TBI, its deficiency has been identified as a predictor of poor outcomes in bleeding trauma patients. The association between fibrinogen concentration and the outcomes of TBI patients has not been described.

Objectives

To describe the relationship between admission fibrinogen levels, in adult patients with severe TBI, and clinical outcomes and resource allocation.

Methods

A retrospective review of all adult severe TBI patients, with admission serum fibrinogen levels [SFL], treated at a Level 1 Trauma Center was conducted from June 1, 2016 to May 31, 2021. SFLs were measured using the Clauss technique and classified as <1, 1-1.5, 1.5-2.0 and >2.0 g/L. Comparative analyses of injury characteristics, laboratory parameters, resource utilization, and outcomes of patients with different fibrinogen levels were performed.

Results

804 severe TBI patients were evaluated, the majority (51.4%) had SFLs ≤2 g/L, and 10% had levels <1 g/L. Most were male [95%], injured in motor vehicle crashes [60%] or falls [24%], and the most common TBI types were subdural hematoma [32%],and subarachnoid hemorrhage [24%]. The median Glasgow Coma Scale score for patients was 3, and the overall mortality rate was 21.8%. The most severe injury parameters and abnormal laboratory results were observed in the patients with the lowest median SFLs. This group also required more interventions, such as intubation, blood transfusions, and MTP implementation (p<0.05). Mortality rates begin to rise at fibrinogen levels below 1.5 g/L, increasing by 263% at levels 1.0 to 1.5 g/L and by 630% at levels < 1.0 g/L (p<0.05).

Conclusion

Low admission SFls in severe TBI patients are associated with worse outcomes and higher resource allocation. Identifying the threshold fibrinogen level for prediction and potential correction should be the focus of future research.

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