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

Qi Zhang; Hong Min Kuang; Du Juan Qiao; Xiang Lin Zhong; Jia Jia Kang; Rui Na Ma; Min Li

doi:10.1089/neur.2023.0068

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

Neurotrauma Rep. 2023 Oct 25;4(1):715-723. doi: 10.1089/neur.2023.0068. eCollection 2023.

Authors

Qi Zhang^{1

2}, Hong Min Kuang^{1

2}, Du Juan Qiao², Xiang Lin Zhong^{1

2}, Jia Jia Kang³, Rui Na Ma⁴, Min Li²

Affiliations

¹ College of Basic Medicine, The Fourth Military Medical University, Xi'an, China.
² Department of Critical Care Medicine, The Second Affiliated Hospitals, The Fourth Military Medical University, Xi'an, China.
³ Department of Neurosurgery, The Fourth Military Medical University, Xi'an, China.
⁴ Department of Pulmonary and Critical Care Medicine, The Fourth Military Medical University, Xi'an, China.

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.