A. Kaple2, I. Catanescu1, M. C. Spalding1 1Grant Medical Center,Trauma,Columbus, OHIO, USA 2Ohio University,Heritage College Of Osteopathic Medicine,Dublin, OHIO, USA
Introduction: Blunt cerebrovascular injury (BCVI) affects 1-2% of all traumas and leads to increased risk of stroke and neurological sequelae if not treated. However, many cases of BCVIs occur in a poly-trauma setting, delaying the initiation of antiplatelet therapies (APT). Such cases include comorbidities like solid organ injury and traumatic brain injury. Though studies have suggested that it is safe to start APT in certain cases, there is a lack of data in regards to timing of therapy initiation. The purpose of our study was to analyze the change in grade of BCVI as a function of initiation of APT.
Methods: This was a retrospective study of blunt traumas with radiographic BCVI diagnosis performed at a level one trauma center from October 2016 to July 2017. Initially, the cohort included 115 patients. Exclusion criteria was defined as; injuries by a penetrating mechanism, atherosclerotic vessels, or confounding artifact on imaging. 104 blunt trauma patients with 153 total blood vessel injuries comprised the study population. Variables analyzed included; neurological exam, medication used for APT, time to initiate treatment, and angiographic findings. Primary outcomes were; death, stroke, resolution or progression of BCVI. Secondary outcomes included; hospital and ICU stay, DVT, sepsis, and cardiac arrest. We defined early treatment as an initiation under 48 hours, between 2-10 days, and greater than 10 days. Patients were organized by Grade of BCVI, and then compared between different treatment initiation times.
Results: Out of 153 BCVIs, 58.2% were Grade 1, 17.6% were Grade 2, 15.7% were Grade 3, 8.5% were Grade 4, and no Grade 5 injuries were encountered. There was a significantly higher mortality for patients with a Grade 4 BCVI (p < 0.05). Regarding the outcomes of Grade 1 BCVIs, there were significant differences when compared to other grades (p < 0.05). However, there was no statistical significance in the timing of treatment versus BCVI progression (p=0.73). For BCVIs treated under 48 hours, 59.6% improved. When treated between 2 and 10 days, 56.3% of BCVIs improved. BCVIs treated after 10 days had an improvement rate of 66.7%. Treatment arms were no different between those injuries that remained the same and those that were not treated (Table 1).
Conclusion: Our study found that Grade 4 BCVI mortality was statistically significant, as well as Grade 1 BCVIs and outcomes. However, when we analyzed BCVI progression, we found that there was no statistical significance between progression and early treatment time. It appears that early treatment may not need to be initiated promptly; however, we acknowledge a limitation is that this calculation is underpowered. Future research will continue to compile BCVI data to enhance our sample size so that a potentially efficacious time period is found to initiate APT.
