Analysis of Modified BIG Scores and Platelet Inhibition in Patients with Traumatic Brain Injuries

Platelet inhibition is known to occur after traumatic brain injury (TBI) and is predictive of bleed progression. The relationship between platelet inhibition and modified brain injury guideline (mBIG) score, however, is unknown. We hypothesize that patients with higher mBIG scores are more likely to have platelet inhibition and bleed progression. Methods: A practice management guideline was established calling for a thromboelastography with platelet mapping (TEG-PM) on all adult trauma patients with an intracranial hemorrhage. Patients were then categorized per the mBIG as 1, 2, or 3. Data was retrospectively collected from December 2019 to December 2021. Patients were considered to have platelet inhibition if the percent arachidonic acid (AA) or percent adenosine diphosphate (ADP) inhibition was ≥60% on TEG-PM. Results: Between December 2019 and December 2021, 768 patients underwent TEG-PM. AA inhibition was more likely to occur in mBIG 3 patients (26.3%) compared to mBIG 1 or mBIG 2 patients (P = 0.08),. ADP and combined AA/ADP inhibition were similar between mBIG scores. Modified BIG 3 patients were more likely to experience bleed progression compared to mBIG 1 or 2 (46.4%; P < 0.001) and to require neurosurgical intervention (16.5%; p < 0.001). Discussion: Our study suggests that the higher the mBIG scores, the more likely patients will have worse outcomes regardless of platelet inhibition. Patients with TBI who experience worse outcomes is multifactorial in nature. TEG-PM should be used in conjunction with clinical judgement for treatment guidance.