The relationship between traumatic brain injury prognosis and MPV (mean platelet volume) parameter in patients presenting with head injury

Objective: The aim of this thesis is to investigate the relationship between MPV (Mean Platelet Volume) and prognosis of patients with intracranial hemorrhage due to head trauma. Trauma patients are among the most common causes of emergency room visits. The site of trauma is also important among the factors affecting the mortality of trauma patients. Head trauma stands out in terms of mortality. It is among the most common causes of young deaths. The focus of the study was to determine the effectiveness of blood pressure, imaging, GCS (Glasgow Coma Scoring), modified shock index and MPV parameters in determining prognosis in patients with intracranial hemorrhage admitted to our emergency department as a result of head trauma. With these parameters, hospitalization units, operation status and outcome status of the patients were evaluated. As a result of this evaluation, it is planned to make a preliminary evaluation about how patient outcomes will be. Another aspect of this study is that the literature is not clear on this issue. In this study, it was planned to contribute to the literature and to give direction to the researches to be conducted. Materials and Methods: Patients with no additional pathology admitted to the Department of Emergency Medicine of Süleyman Demirel University Research and Application Hospital between 15.01.2023 and 15.07.2023 due to head trauma were included in the study. A total of 96 patients were included in the study. Age, gender, GCS, vitals (blood pressure, pulse, respiratory rate, saturation), platelet count (PLT), hemoglobin (Hb), Mean Platelet Volume (MPV), modified shock index, Rotterdam Score, brain CT (Computed Tomography) results, place of hospitalization, operation status, and outcome status of the patients included in the study were examined via the Hospital Information Management System (HIMS). Patients whose data could not be accessed, who presented with multiple traumas other than head trauma, who had additional pathologies, who were under 18 years of age and who were pregnant were excluded from the study. Data were analyzed with SPSS-23 (Statistical Package for Social Science-23) and MedCalc 22 version. The conformity of the data to normal distribution was evaluated by Kolmogorov-Smirnov Test. Descriptive statistics were shown as mean ± standard deviation or median (min-max) for continuous variables. Pearson's Chi-Square Test and Fisher's Chi-Square with Fisher's Exact Test were used to analyze categorical variables. Dependent T test was used in the analysis of dependent variables and Independent T Test was used in the analysis of independent quantitative data. P < 0.05 was accepted as the level of statistical significance. Findings: 96 patients were included in the study. Among the parameters used in the study, systolic blood pressure, diastolic blood pressure, GCS, modified shock index/GCS ratio were significant in determining the place of hospitalization, while age, pulse rate, saturation, modified shock index, hemoglobin, MPV and Rotterdam score were not significant. When the factors affecting the outcome of the patients were analyzed, systolic blood pressure, mean platelet volume (MPV), GCS score, Rotterdam score and modified shock index/GCS ratio were found to be significant according to Mann-Whitney U test. Conclusion: Among trauma patients, head trauma is prominent in terms of mortality. The 96 patients included in this study were older than 18 years of age and non-pregnant. Of the adult patients diagnosed with traumatic brain injury, 62 (64.6%) were male and 34 (35.9%) were female. The ages of the patients admitted to the emergency department with head trauma ranged from 18 years to 89 years with a mean age of 49.77±20.11 years. The Glasgow Coma score (GCS) of the patients included in the study was calculated and classified according to the score. Those with a GCS of 14-15 were classified as mild TBI, those with a GCS of 9-13 were classified as moderate TBI, and those with a GCS of 8 or less were classified as severe TBI. Of the 96 patients examined in the study, 50% were in the mild group, 19.79% in the moderate group and 30.21% in the severe group. Among the patients admitted to the emergency department with head trauma, 41 (42.70%) had subarachnoid hemorrhage (SAH), 28 (29.16%) had subdural hemorrhage, 9 (9.37%) had epidural hemorrhage, 13 (13.54%) had epidural and subdural hemorrhage, and 5 (5.20%) had cerebral contusion. Of the 96 patients analyzed in the study, 25 (26.0%) were operated on and 71 (74%) were followed up under observation. Of the patients diagnosed with traumatic brain injury, 82 (85.4%) were followed up in the intensive care unit and 14 (14.6%) in the ward. Thirty-three (34.37%) of the patients died and 63 (65.62%) were discharged with cure. When the factors affecting the outcome of the patients were analyzed, systolic blood pressure, mean platelet volume (MPV), GCS, Rotterdam Score and modified shock index/GCS ratio were found to be significant. In Roc analysis, the area under the curve AUC value was highest for GCS (AUC value 0.893) and MPV (AUC value 0.865) was the second highest. MPV was found to be the most independent factor affecting mortality after GCS.