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The Unrecognized Epidemic of Blunt Carotid Arterial Injuries: Early Diagnosis Improves Neurologic Outcome

Biffl, Walter L. MD*; Moore, Ernest E. MD*; Ryu, Robert K. MD; Offner, Patrick J. MD*; Novak, Zina MD; Coldwell, Douglas M. MD, PhD; Franciose, Reginald J. MD*; Burch, Jon M. MD*

Scientific Papers

Objective To determine the benefit of screening for blunt carotid arterial injuries (BCI) in patients who are asymptomatic.

Summary Background Data Blunt carotid arterial injuries have the potential for devastating complications. Published studies report 23% to 28% mortality rates, with 48% to 58% of survivors having permanent severe neurologic deficits. Most patients have neurologic deficits when the injury is diagnosed. The authors hypothesized that screening patients who are asymptomatic and instituting early therapy would improve neurologic outcome.

Methods The Trauma Registry of the author's Level I Trauma Center identified patients with BCI from 1990 through 1997. Beginning in August 1996, the authors implemented a screening for BCI. Arteriography was used for diagnosis. Patients without specific contraindications were anticoagulated. Endovascular stents were deployed in the setting of pseudoaneurysms.

Results Thirty-seven patients with BCI were identified among 15,331 blunt-trauma victims (0.24%). During the screening period, 25 patients were diagnosed with BCI among 2902 admissions (0.86%); 13 (52%) were asymptomatic. Overall, eight patients died, and seven of the survivors had permanent severe neurologic deficits. Excluding those dying of massive brain injury and patients admitted with coma and brain injury, mortality associated with BCI was 15%, with severe neurologic morbidity in 16% of survivors. The patients who were asymptomatic at diagnosis had a better neurologic outcome than those who were symptomatic. Symptomatic patients who were anticoagulated showed a trend toward greater neurologic improvement at the time of discharge than those who were not anticoagulated.

Conclusions Screening allows the identification of asymptomatic BCI and thereby facilitates early systemic anticoagulation, which is associated with improved neurologic outcome. The role of endovascular stents in the treatment of blunt traumatic pseudoaneurysms remains to be defined.

From the Departments of Surgery* and Radiology,† Denver Health Medical Center and University of Colorado Health Sciences Center Denver, Colorado

Presented at the 118th Annual Meeting of the American Surgical Association, April 3, 1998, Palm Beach, Florida.

Address correspondence and reprint requests to Walter L. Biffl, MD, Department of Surgery, Box 0206, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204-4507.

Accepted for publication April 1998.

© 1998 Lippincott Williams & Wilkins, Inc.