C. Slovacek2, H. Indupuru1,2, E. Fox1,2, S. Savitz1,2, M. McNutt1,2 1Memorial Hermann Hospital,Red Duke Trauma Institute,Houston, TX, USA 2McGovern Medical School at UTHealth,Houston, TX, USA
Introduction: While evidence based medicine guides early diagnosis and treatment of blunt cerebrovascular injury (BCVI) to decrease stroke rates, there is a paucity of trauma research addressing other etiologies of stroke including atherosclerotic disease and atrial fibrillation. Both are age-related diseases that should contribute to a rising stroke rate with the increasing age of the trauma population. The purpose of this study is to evaluate the incidence, treatment, and etiology of strokes in our trauma population, and for those related to BCVI to evaluate the impact that screening and treatment guidelines have on the incidence of BCVI-related strokes.
Methods: This study was a retrospective review of all adult trauma patients admitted to a level 1 hospital who suffered a stroke during trauma admission from 2010 to 2017. Data was collected from two prospectively maintained databases by the UTHealth Trauma and Stroke services. Chi-squared test was performed for trends in proportions. Mann-Whitney U test was used to compare continuous variables.
Results:Of the 43,674 adult blunt trauma patients admitted during the study period, 97 (0.2%) were diagnosed with a stroke during the index admission, of which 22% were caused by BCVI. The age and volume of trauma patients increased during the study period as did the incidence of BCVI (p<0.001). While the incidence of all strokes increased over time (p<0.001), this was associated with a decrease in BCVI strokes and an increase in non-BCVI strokes. Of our patients with BCVI-related strokes, 79% received appropriate anti-thrombotic therapy at a median of 6 hours and 59 minutes from time of arrival. Patients with non-BCVI strokes (78% of the stroke population) had a higher median age (71 vs 44, p<0.001), lower median ISS (12 vs 26, p<0.001) and similar length of stay (12 vs 14 days, p=0.986) compared to patients with stroke secondary to BCVI. The mortality rate for BCVI strokes and non-BCVI strokes were 38% and 22% respectively, and patients with BCVI strokes were 1.7 times more likely to die than non-BCVI strokes (RR: 1.70, 95%CI: 0.86-3.39, p=0.14).
Conclusion: Strokes are rare in the trauma population but are increasing as the trauma population ages. Despite a large volume of evidence for BCVI treatment and stroke prevention, the majority of strokes are secondary to advanced age and comorbidities. Medical optimization of comorbid conditions during trauma hospitalization will become increasingly important for stroke prevention as the population ages.
