Early treatment of blunt cerebrovascular injury with concomitant hemorrhagic neurologic injury is safe and effective

Rachael A. Callcut, Dennis J. Hanseman, Patrick D. Solan, Kurt S. Kadon, Nichole K. Ingalls, Gerald R. Fortuna, Betty J. Tsuei, Bryce R.H. Robinson

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Early pharmacologic treatment for blunt cerebrovascular injury (BCVI) is often withheld when concomitant traumatic brain injury or cervical spinal cord injury occurs. This study examines the safety and efficacy of early treatment for patients with both BCVI and traumatic neurologic injury (TNI). METHODS: Ten-year retrospective review of patients with BCVI and a TNI was performed. Stroke outcomes for those treated with pharmacologic therapy for their BCVI were compared with those not treated. In addition, the likelihood of worsening of TNI was determined for those exposed to pharmacologic therapy compared with those not exposed. Multivariate logistic regression techniques were used to analyze adjusted odds ratio for stroke risk. RESULTS: Seventy-seven patients were identified with BCVI + TNI. Strokes occurred in 27% patients with 3 of 21 (14%) strokes present at arrival. There were no differences in baseline characteristics between groups. Stroke rate was higher in the untreated group compared with treated (57% vs. 4%, p < 0.0001). On multivariate regression, treatment status was the most significant stroke predictor (adjusted odds ratio 4.4, 3.0-6.5, p < 0.0001, c-stat 0.93). There was no difference in risk of hemorrhagic deterioration of traumatic brain injury based on pharmacologic exposure versus no exposure (5% vs. 6%, p = 0.6). Likewise, no patient with spinal cord injury worsened as a result of pharmacologic exposure. Of the potentially preventable strokes, 24% (4 of 17) resulted in a stroke-related death and all four deaths occurred in the untreated group. CONCLUSION: The benefit of early treatment for BCVI markedly outweighs the risk of treatment for patients suffering concomitant BCVI and hemorrhagic neurologic injury.

Original languageEnglish (US)
Pages (from-to)338-346
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume72
Issue number2
DOIs
StatePublished - Feb 2012
Externally publishedYes

Keywords

  • Blunt cerebrovascular injury
  • Carotid injury
  • Traumatic brain injury
  • Vertebral injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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