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21JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Correlation of D-Dimer level with outcome in traumatic 

brain injury

Pradip Prasad Subedi 1 , Sushil Krishna Shilpakar 2

Email:

Abstract

Introduction

immense. The major determinant of outcome following TBI is the severity of the primary injury. 

management of TBI.

Methods

Results

Conclusion

Key words

Original Article



22JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Introduction

mechanical force applied to the cranium and the intracranial 

contents, leading to temporary or permanent impairments, 
1,2

according to specialities and circumstances.  Often the 

inclusion criteria.3

In patients with multiple trauma, head is the most common 

are treated and discharged from the emergency department.

8

9  The incidence in China is 

11

for multiple reasons, including inconsistencies and 

complexities of diagnostic coding and inclusion criteria, 

hospital admissions versus door-to-door surveys), transfers 

to multiple care facilities (for example, patient admissions 

practices.12

The true data of the incidence of head injury in Nepal and its 

13

centres outside the capital, most cases are either referred 

many as two thirds of those with moderate head injury will 

  This cost of head injury is a 

Besides, head injury involves the younger productive age 

community.

adults and fall injury in children.

injury.

The prognosis of head injury depends on various factors. 

individual after TBI. The major determinant of outcome 

from TBI is the severity of the primary insult, which 

hypotension, hypoxia, hyperpyrexia, and hypoglycaemia 

TBI.11

coagulopathy has major impact on the outcome of the 

patients.18 This study is done to see the correlation of 



23JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Figure 1: Formation of D-dimer 45

Objectives

Primary objective

Secondary objectives

Hypothesis

Null hypothesis (H0)

Alternate hypothesis (H1)

Materials and methods

ninety four patients were admitted with the diagnosis of 

met the inclusion criteria were included in the study.

Inclusion criteria

Exclusion criteria

Patients on anticoagulants 

Polytrauma

Indication of admission

vomiting and seizure

Patients presenting to the emergency department with

of the injury. Patients were followed up and evaluated 

record of mortality were collected in a preset proforma. 



JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Outcome variables

Primary outcome:

Secondary outcome:

1. GCS: GCS score was determined using following guidelines:

48

Points Best eye opening Best verbal response Best motor response

- -

- Oriented

Spontaneous Confused Withdraws to pain

3 To speech Inappropriate words Flexion to pain (decorticate)

2 To pain

1 None None None

Glasgow coma scale  (recommended for age < 4 yrs) 48

Points Best eye opening Best verbal response Best motor response
- -

- Smiles, oriented to sound, 

Spontaneous Crying Interaction Withdraws to pain

Inappropriate

3 To speech Moaning Flexion (decorticate)

2 To pain Restless

1 None None None None

2. Severity of head injury : Severity of head injury was graded based on GCS score.

Severity GCS

Mild

Moderate 9-12

Severe 1-8

3. Glasgow outcome scale: The Glasgow outcome scale is a 5 level score:49



JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

4. Duration of illness: time period between trauma and 

measured in hours in this study.

5. Duration of hospital stay: Number of days the patient 

is in hospital. Staying for a night is taken as one day.

6. Normal D-dimer level: < 200ng/mL

Statistical Analysis

The data were analyzed using the Statistical program for 

used to study the correlation of mode of injury and grade of 

Results

One hundred and ninety four patients were admitted with 

study after meeting the inclusion and exclusion criteria. 

twenty one to forty years of age. The mean duration of 

Figure 2 : Bar diagram showing distribution of patients 

according to age

Figure 3: Figure showing the frequency of patients in 

different sexes

The most common cause of TBI was fall injury which 

Figure 4: Figure showing frequency of patients with 

different modes of injury

sustained moderate head injury and twenty six patients 



JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Table 1: Lesions in CT scan of the head

Number Percentage

22.9

28.3

28 18.9

Contusion

12 8.1

Pneumocephalus 12 8.1

hemorrhage
19 12.8

1

1

Table 2: Number of patients with normal and elevated 

D-dimer level

D-dimer level Frequency Percentage (%)

31.1

Table 3: Man-Whitney test showing correlation between 

D-dimer and duration of hospital stay, duration of ICU 

stay and GOS

Man-whitney Test (Ranks)

D-dimer N Mean Rank

hospital stay

Total

39.82

Total

Total

Test statistics

Duration of 

Hospital Stay
GOS ICU Stay

Mann-

Wilcoxon W

Z -3.312

(2-tailed)



JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Table 4: Chi-square test showing correlation of D-dimer 

with grade of injury

Grade of Injury Total

Mild Moderate Severe

82

22

Total 92

Chi-Square tests

Value df
Asymp. Sig. 

(2-sided)
a 2

2

Table 5: Chi-square test showing correlation of D-dimer 

with mode of injury

Mode of Injury Total

Fall Others
Physical

38

19 2

Total 11

Value df Asymp. Sig. (2-sided)

a 3

3

Discussion

institution of resuscitative measures with simultaneous 

the early management to improve outcome in head injury. 

The severity of the primary injury generally dictates the 

outcome; nevertheless secondary injuries have a profound 

the secondary phenomenons after a TBI is the hemostatic 

that of the International mission on prognosis and analysis 

age of maximum economic productivity. Thirty six patients 

 . In our study the most common cause of head injury was 

sustained mild head injuries similar to other injuries as 

facilities within the capital only.

The most common intracranial lesion in our study was 

Naseri et al 

 Out of 

et al .

Limitations of the study



28JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

institute

Conclusion

and early treatment may help in recovery.

References

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development and international validation of 

2.

3.

medscape.com

th

department visits, hospitalizations, and deaths. 

Prevention, National Center for Injury Prevention 

National Center for Injury Prevention and Control. 

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9.

11.

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13.

Surgeons of Nepal.

th ed. 

18.

level with poor outcome in traumatic intracranial 

19.

Klein MJ. Post head injury endocrine complications; 

medscape.com



29JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

21.

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in warfarinised patients. Singapore Med J 

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and recommendations for return to activity. Clinical 

28. Macpherson BCM, Macpherson P, Jennett B. CT 

incidence of intracranial contusion and hematoma

29.

extra dual hematoma of delayed onset is not a rarity. 

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and recommendations for return to activity. Clinical 

Surgery. 18th

consortium survey of head injuries. Neurosurgery 

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axonal injury and traumatic coma in the primate. 

39.

with closed head injuries and their role in predicting 



JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

attended the emergency department with head 

comparisons of analysis of the condition in children 


