Early repeat imaging is not warranted for high-grade blunt cerebrovascular injuries

Amy E. Wagenaar, Clay Cothren Burlew, Walter L. Biffl, Kathryn M. Beauchamp, Fredric M. Pieracci, Robert T. Stovall, Gregory Jurkovich, Ernest E. Moore

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

RESULTS: During the 16-year study, 582 patients sustained 829 BCVIs; there were 420 carotid artery injuries and 409 vertebral artery injuries. The majority (78%) received antithrombotic therapy. For the 296 carotid artery injuries (70%) with repeat imaging, there was complete healing of the injury in 56% of Grade I, 20% of Grade II, 5% of Grade III, and 0% of Grade IV injuries. For the 255 vertebral artery injuries (62%) with repeat imaging, there was a resolution of the injury in 56% of Grade I, 17% of Grade II, 14% of Grade III, and 3% of Grade IV injuries. For BCVIs overall, there was healing documented in 56% of Grade I, 18% of Grade II, 8% of Grade III, and 2% of Grade IV injuries.

CONCLUSION: Injury grade of BCVIs is associated with the healing rate of the injury. While approximately half of Grade I BCVIs resolved, only 7% of all high-grade injuries healed. Early repeat imaging may not be warranted in high-grade BCVI; the vast majority of injuries do not resolve. The cost, radiation, and transport risk of early repeat imaging should be weighed against the potential treatment impact for individual patients.

LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.

BACKGROUND: The current management for blunt cerebrovascular injuries (BCVIs) includes repeat imaging 7 days to 10 days after initial diagnosis. This recommendation, however, has not been systematically evaluated. The purpose of this study was to evaluate the impact of early repeat imaging on treatment course. We hypothesized that a minority of patients with high-grade injuries (Grades III and IV) have complete resolution of their injuries early in their treatment course and hence repeat imaging does not alter their therapy.

METHODS: Our prospective BCVI database was queried from January 1, 1997, to January 1, 2013. Injuries were graded according to the Denver scale. Injuries, treatment, and imaging results were analyzed. BCVI healing was defined as a complete resolution of the injury.

Original languageEnglish (US)
Pages (from-to)540-545
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number4
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Nonpenetrating Wounds
Wounds and Injuries
Carotid Artery Injuries
Vertebral Artery
Therapeutics

Keywords

  • Antithrombotics
  • Blunt cerebrovascular injury
  • Carotid artery injury
  • Trauma
  • Vertebral artery injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Wagenaar, A. E., Burlew, C. C., Biffl, W. L., Beauchamp, K. M., Pieracci, F. M., Stovall, R. T., ... Moore, E. E. (2014). Early repeat imaging is not warranted for high-grade blunt cerebrovascular injuries. Journal of Trauma and Acute Care Surgery, 77(4), 540-545. https://doi.org/10.1097/TA.0000000000000418

Early repeat imaging is not warranted for high-grade blunt cerebrovascular injuries. / Wagenaar, Amy E.; Burlew, Clay Cothren; Biffl, Walter L.; Beauchamp, Kathryn M.; Pieracci, Fredric M.; Stovall, Robert T.; Jurkovich, Gregory; Moore, Ernest E.

In: Journal of Trauma and Acute Care Surgery, Vol. 77, No. 4, 01.01.2014, p. 540-545.

Research output: Contribution to journalArticle

Wagenaar, AE, Burlew, CC, Biffl, WL, Beauchamp, KM, Pieracci, FM, Stovall, RT, Jurkovich, G & Moore, EE 2014, 'Early repeat imaging is not warranted for high-grade blunt cerebrovascular injuries', Journal of Trauma and Acute Care Surgery, vol. 77, no. 4, pp. 540-545. https://doi.org/10.1097/TA.0000000000000418
Wagenaar, Amy E. ; Burlew, Clay Cothren ; Biffl, Walter L. ; Beauchamp, Kathryn M. ; Pieracci, Fredric M. ; Stovall, Robert T. ; Jurkovich, Gregory ; Moore, Ernest E. / Early repeat imaging is not warranted for high-grade blunt cerebrovascular injuries. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 77, No. 4. pp. 540-545.
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abstract = "RESULTS: During the 16-year study, 582 patients sustained 829 BCVIs; there were 420 carotid artery injuries and 409 vertebral artery injuries. The majority (78{\%}) received antithrombotic therapy. For the 296 carotid artery injuries (70{\%}) with repeat imaging, there was complete healing of the injury in 56{\%} of Grade I, 20{\%} of Grade II, 5{\%} of Grade III, and 0{\%} of Grade IV injuries. For the 255 vertebral artery injuries (62{\%}) with repeat imaging, there was a resolution of the injury in 56{\%} of Grade I, 17{\%} of Grade II, 14{\%} of Grade III, and 3{\%} of Grade IV injuries. For BCVIs overall, there was healing documented in 56{\%} of Grade I, 18{\%} of Grade II, 8{\%} of Grade III, and 2{\%} of Grade IV injuries.CONCLUSION: Injury grade of BCVIs is associated with the healing rate of the injury. While approximately half of Grade I BCVIs resolved, only 7{\%} of all high-grade injuries healed. Early repeat imaging may not be warranted in high-grade BCVI; the vast majority of injuries do not resolve. The cost, radiation, and transport risk of early repeat imaging should be weighed against the potential treatment impact for individual patients.LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.BACKGROUND: The current management for blunt cerebrovascular injuries (BCVIs) includes repeat imaging 7 days to 10 days after initial diagnosis. This recommendation, however, has not been systematically evaluated. The purpose of this study was to evaluate the impact of early repeat imaging on treatment course. We hypothesized that a minority of patients with high-grade injuries (Grades III and IV) have complete resolution of their injuries early in their treatment course and hence repeat imaging does not alter their therapy.METHODS: Our prospective BCVI database was queried from January 1, 1997, to January 1, 2013. Injuries were graded according to the Denver scale. Injuries, treatment, and imaging results were analyzed. BCVI healing was defined as a complete resolution of the injury.",
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N2 - RESULTS: During the 16-year study, 582 patients sustained 829 BCVIs; there were 420 carotid artery injuries and 409 vertebral artery injuries. The majority (78%) received antithrombotic therapy. For the 296 carotid artery injuries (70%) with repeat imaging, there was complete healing of the injury in 56% of Grade I, 20% of Grade II, 5% of Grade III, and 0% of Grade IV injuries. For the 255 vertebral artery injuries (62%) with repeat imaging, there was a resolution of the injury in 56% of Grade I, 17% of Grade II, 14% of Grade III, and 3% of Grade IV injuries. For BCVIs overall, there was healing documented in 56% of Grade I, 18% of Grade II, 8% of Grade III, and 2% of Grade IV injuries.CONCLUSION: Injury grade of BCVIs is associated with the healing rate of the injury. While approximately half of Grade I BCVIs resolved, only 7% of all high-grade injuries healed. Early repeat imaging may not be warranted in high-grade BCVI; the vast majority of injuries do not resolve. The cost, radiation, and transport risk of early repeat imaging should be weighed against the potential treatment impact for individual patients.LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.BACKGROUND: The current management for blunt cerebrovascular injuries (BCVIs) includes repeat imaging 7 days to 10 days after initial diagnosis. This recommendation, however, has not been systematically evaluated. The purpose of this study was to evaluate the impact of early repeat imaging on treatment course. We hypothesized that a minority of patients with high-grade injuries (Grades III and IV) have complete resolution of their injuries early in their treatment course and hence repeat imaging does not alter their therapy.METHODS: Our prospective BCVI database was queried from January 1, 1997, to January 1, 2013. Injuries were graded according to the Denver scale. Injuries, treatment, and imaging results were analyzed. BCVI healing was defined as a complete resolution of the injury.

AB - RESULTS: During the 16-year study, 582 patients sustained 829 BCVIs; there were 420 carotid artery injuries and 409 vertebral artery injuries. The majority (78%) received antithrombotic therapy. For the 296 carotid artery injuries (70%) with repeat imaging, there was complete healing of the injury in 56% of Grade I, 20% of Grade II, 5% of Grade III, and 0% of Grade IV injuries. For the 255 vertebral artery injuries (62%) with repeat imaging, there was a resolution of the injury in 56% of Grade I, 17% of Grade II, 14% of Grade III, and 3% of Grade IV injuries. For BCVIs overall, there was healing documented in 56% of Grade I, 18% of Grade II, 8% of Grade III, and 2% of Grade IV injuries.CONCLUSION: Injury grade of BCVIs is associated with the healing rate of the injury. While approximately half of Grade I BCVIs resolved, only 7% of all high-grade injuries healed. Early repeat imaging may not be warranted in high-grade BCVI; the vast majority of injuries do not resolve. The cost, radiation, and transport risk of early repeat imaging should be weighed against the potential treatment impact for individual patients.LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.BACKGROUND: The current management for blunt cerebrovascular injuries (BCVIs) includes repeat imaging 7 days to 10 days after initial diagnosis. This recommendation, however, has not been systematically evaluated. The purpose of this study was to evaluate the impact of early repeat imaging on treatment course. We hypothesized that a minority of patients with high-grade injuries (Grades III and IV) have complete resolution of their injuries early in their treatment course and hence repeat imaging does not alter their therapy.METHODS: Our prospective BCVI database was queried from January 1, 1997, to January 1, 2013. Injuries were graded according to the Denver scale. Injuries, treatment, and imaging results were analyzed. BCVI healing was defined as a complete resolution of the injury.

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