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Functional outcomes following blunt cerebrovascular injury

DiCocco, Jennifer M. MD; Fabian, Timothy C. MD; Emmett, Katrina P. MD; Magnotti, Louis J. MD; Zarzaur, Ben L. MD, MPH; Khan, Nickalus BS; Kelly, Jayna M. BS; Croce, Martin A. MD

Journal of Trauma and Acute Care Surgery: April 2013 - Volume 74 - Issue 4 - p 955–960
doi: 10.1097/TA.0b013e318287800f
CME Articles
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BACKGROUND There has been much debate on whom to screen, how to screen, and how to treat blunt cerebrovascular injury (BCVI), but there has been little published on long-term functional outcomes following diagnosis and treatment of BCVI. This study was conducted to address those long-term outcomes.

METHODS Patients with BCVI during a 53-month period ending June 2009 were identified. Charts were reviewed for demographics, associated injuries, treatments, strokes, and in-hospital mortality. Posthospital discharge follow-up was conducted. A structured telephone interview was performed using a functional independence measurement–functional activity measurement questionnaire consisting of 30 questions in seven categories (self-care, sphincter control, mobility, locomotion, communication, psychosocial, and cognitive). Each question was scored from 1 (requires full assistance) to 7 (fully independent). Outcomes were compared by type of BCVI, associated injuries, and stroke.

RESULTS Two hundred twenty-two patients with BCVI were identified. Twenty-four patients died during their initial hospitalization, and an additional 11 patient died after hospital discharge. The 68 patients who completed the interview constituted our study population. Mean follow-up was 35 months. Of a possible 210 points, the mean total score on functional independence measurement and functional activity measurement was 186, 185, and 188 for all patients, carotid artery injuries, and vertebral arteries injuries, respectively. A significant difference was seen when comparing patients with and without strokes (173 and 189, respectively).

CONCLUSION This is the first report of functional outcomes following BCVI. We found that carotid and vertebral artery injuries have similar functional outcomes. As would be expected, the development of stroke led to worse outcomes. This underscores the importance of early diagnosis and initiation of therapy. Prevention of stroke in patients with BCVI leads to near-normal functional outcomes.

LEVEL OF EVIDENCE Epidemiologic/prognostic study, level III.

From the Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.

Submitted: February 7, 2011, Revised: December 13, 2012, Accepted: December 18, 2012.

The study was presented at the 41st annual meeting of the Western Trauma Association in Big Sky, Montana, on March 1, 2011.

Address for reprints: Timothy C. Fabian, MD, Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Suite 203 Memphis, TN 38163; email tfabian@uthsc.edu.

© 2013 Lippincott Williams & Wilkins, Inc.