Carotid artery dissection and motor vehicle trauma: patient demographics, associated injuries and impact of treatment on cost and length of stay

Abstract

BackgroundBlunt carotid arterial injury (BCI) is a rare injury associated with motor vehicle collision (MVC). There are few population based analyses evaluating carotid injury associated with blunt trauma and their associated injuries as well as outcomes.MethodsThe Nationwide Inpatient Sample (NIS) 2003–2010 data was queried to identify patients after MVC who had documented BCI during their hospitalizations utilizing ICD-9-CM codes. Demographics, associated injuries, interventions performed, length of stay, and cost were evaluated.Results1,686,867 patients were estimated having sustained MVC; 1,168 BCI were estimated. No patients with BCI had open repair, 4.24 % had a carotid artery stent (CAS), and 95.76 % of patients had no operative intervention. Age groups associated with BCI were: 18–24 (27.8 %), 47–60 (22.3 %), 35–46 (20.6 %), 25–34 (19.1 %), >61 (10.2 %). Associated injuries included long bone fractures (28.5 %), stroke and intracranial hemorrhage (28.5 %), cranial injuries (25.6 %), thoracic injuries (23.6 %), cervical fractures (21.8 %), facial fractures (19.9 %), skull fractures (18.8 %), pelvic fractures (18.5 %), hepatic (13.3 %) and splenic (9.2 %) injuries. Complications included respiratory (44.2 %), bleeding (16.1 %), urinary tract infections (8.9 %), and sepsis (4.9 %). Overall mortality was 14.1 % without differences with regard to intervention (18.5 % vs. 13.9 %; P = 0.36). Stroke and intracranial hemorrhage was associated with a 2.7 times greater risk of mortality. Mean length of stay for patients with BCI undergoing stenting compared to no intervention were similar (13.1 days vs. 15.9 days) but had a greater mean cost ($83,030 vs. $63,200, p = 0.3).ConclusionBCI is a rare injury associated with MVC, most frequently reported in younger patients. Frequently associated injuries were long bone fractures, stroke and intracranial hemorrhage, thoracic injuries, and pelvic fractures which are likely associated with the force/mechanism of injury. The majority of patients were treated without intervention, but when CAS was utilized, it did not impact mortality and trended toward increased costs.

Vertebrobasilar and internal carotid arteries dissection in 188 patients

“…Blunt trauma as a cause of dissection is reported in 25-40% [19,23,24,33,34,37,38,46,59,[72][73][74], which is somewhat less frequent than in our patients (42.6%) (Table 5). Blunt neck trauma may have either a direct effect, e.g.…”

“…Since the ICA, VA and basilar artery (BA) dissections (ICAD and VBAD) are usually presented as case reports [6,37,38,[46][47][48][49][50][51][52][53][54][55][56] or as smaller groups of patients [1,8,27,36,41,43,[57][58][59][60][61][62][63], we decided to present them in a group of 188 patients. In addition to a detailed examination of each patient, a comparison between the ICAD and VBAD will be presented as well.…”

Blunt carotid injury with thrombotic occlusion: Is an intervention always required for best outcome?

“…High grade blunt carotid injuries have stroke rates ranging from 26% in Grade 3 (pseudoaneurysm) to 100% in grade 5 (transection) [2]. Optimal treatment remains unclear [4,5]. Due to high rates of stroke in these patients, intervention is advocated, whether surgical or interventional radiological [2].…”

“…Prognosis and neurological outcome in BCVI is highly associated with GCS at presentation [2]. In symptomatic patients, the period to development of stroke is highly variable, ranging from 6 h to 53 h [4,7,8]. Delayed presentation with rupture in asymptomatic patients has been documented as late as 2 weeks after trauma without any deficit, putting a natural history of CCA occlusion to speculation [[9], [10], [11]].…”

“…Some researchers have started questioning the utility of stenting in BCVI [4,13,14]. In fact, indications of stenting have been narrowed down to enlarging pseudoaneurysms and dissection with near-complete stenosis [14,15].…”