RESUMEN
BACKGROUND: Blunt vascular neck injuries (BVNIs) are rare, often occult, and potentially devastating injuries. The purpose of this study was to identify a high-risk group, which would benefit from screening. METHODS: Patients with BVNIs were identified from our trauma registry and charts were reviewed. Potential risk factors for BVNI were evaluated by univariate and multivariate logistic regression. RESULTS: Thirty-one BVNIs were identified in 22 patients. The stroke rate was 60% and the mortality rate was 25%. Univariate analysis showed Glasgow Coma Scale score < or = 8, head injury (Abbreviated Injury Scale [AIS] score > or = 3), basal skull fracture, facial injury, other neck injury, thorax injury (AIS score > or = 3), abdominal injury, and cervical spine injury to be significant (p < 0.05). The multivariate predictive model had two predictors remaining significant: thorax injury (AIS [thorax] score > or = 3) and Glasgow Coma Scale score < or = 8. CONCLUSION: Screening should be undertaken for patients at increased risk for BVNI: those with risk factors identified in our regression analysis and factors previously reported.
Asunto(s)
Traumatismos de las Arterias Carótidas/diagnóstico , Traumatismos de las Arterias Carótidas/epidemiología , Hospitales Generales/estadística & datos numéricos , Traumatismos del Cuello/diagnóstico , Traumatismos del Cuello/epidemiología , Evaluación de Resultado en la Atención de Salud , Adulto , Encéfalo/irrigación sanguínea , Colombia Británica/epidemiología , Traumatismos de las Arterias Carótidas/diagnóstico por imagen , Traumatismos de las Arterias Carótidas/patología , Estudios de Casos y Controles , Angiografía Cerebral/estadística & datos numéricos , Árboles de Decisión , Femenino , Escala de Coma de Glasgow , Humanos , Puntaje de Gravedad del Traumatismo , Modelos Logísticos , Masculino , Traumatismos del Cuello/diagnóstico por imagen , Traumatismos del Cuello/patología , Guías de Práctica Clínica como Asunto , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/epidemiología , Heridas no Penetrantes/patologíaRESUMEN
BACKGROUND: Blunt carotid injuries are rare, often occult, and potentially devastating. Angiographic screening programs have detected this injury in up to 1% of blunt trauma patients. Implementing a liberal angiographic screening program at our hospital is impractical and we want to identify a high-risk group to target for screening. We hypothesize that intracranial and extracranial carotid injuries have different risks, presentations, and outcomes. METHODS: Patients with intracranial and extracranial carotid injuries were identified from the British Columbia trauma registry. Presentation and outcome were reviewed. To facilitate statistical modeling the analysis was done by matching cases to 5 randomly selected controls. Risk factors for injury were evaluated by univariate and multiple logistic regression. RESULTS: A total of 35 carotid injuries were identified. Thirteen intracranial injuries were identified in 10 patients. Twenty-two extracranial injuries were identified in 18 patients. Sixty-seven percent of patients with intracranial injuries and 31% of those with extracranial injuries died (P = 0.11). Eleven percent of intracranial injuries and 56% of extracranial injuries were occult (P = 0.04). Glasgow outcome scores were 2.04 intracranial and 3.12 extracranial (P = 0.18). For intracranial injuries the multiple variable predictive model had two predictors: Glasgow Coma Score or =3). CONCLUSIONS: Intracranial injuries were frequently detected on initial investigations and have very poor outcomes. Extracranial injuries were more frequently occult and stand to benefit from early detection by screening programs. As independent risk factors for these two injuries differ, limited screening resources should focus on risk factors for occult extracranial injury: namely, low GCS and significant thoracic injury.