Document Detail


Early treatment of blunt cerebrovascular injury with concomitant hemorrhagic neurologic injury is safe and effective.
MedLine Citation:
PMID:  22327975     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Early pharmacologic treatment for blunt cerebrovascular injury (BCVI) is often withheld when concomitant traumatic brain injury or cervical spinal cord injury occurs. This study examines the safety and efficacy of early treatment for patients with both BCVI and traumatic neurologic injury (TNI).
METHODS: Ten-year retrospective review of patients with BCVI and a TNI was performed. Stroke outcomes for those treated with pharmacologic therapy for their BCVI were compared with those not treated. In addition, the likelihood of worsening of TNI was determined for those exposed to pharmacologic therapy compared with those not exposed. Multivariate logistic regression techniques were used to analyze adjusted odds ratio for stroke risk.
RESULTS: Seventy-seven patients were identified with BCVI + TNI. Strokes occurred in 27% patients with 3 of 21 (14%) strokes present at arrival. There were no differences in baseline characteristics between groups. Stroke rate was higher in the untreated group compared with treated (57% vs. 4%, p < 0.0001). On multivariate regression, treatment status was the most significant stroke predictor (adjusted odds ratio 4.4, 3.0-6.5, p < 0.0001, c-stat 0.93). There was no difference in risk of hemorrhagic deterioration of traumatic brain injury based on pharmacologic exposure versus no exposure (5% vs. 6%, p = 0.6). Likewise, no patient with spinal cord injury worsened as a result of pharmacologic exposure. Of the potentially preventable strokes, 24% (4 of 17) resulted in a stroke-related death and all four deaths occurred in the untreated group.
CONCLUSION: The benefit of early treatment for BCVI markedly outweighs the risk of treatment for patients suffering concomitant BCVI and hemorrhagic neurologic injury.
LEVEL OF EVIDENCE: : III.
Authors:
Rachael A Callcut; Dennis J Hanseman; Patrick D Solan; Kurt S Kadon; Nichole K Ingalls; Gerald R Fortuna; Betty J Tsuei; Bryce R H Robinson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  72     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-13     Completed Date:  2012-05-04     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  338-45; discussion 345-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA. rcallcut@stanford.edu.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Anticoagulants / therapeutic use*
Brain Injuries / complications,  diagnosis,  drug therapy*,  mortality
Cerebral Angiography
Chi-Square Distribution
Child
Female
Head Injuries, Closed / complications,  diagnosis,  drug therapy*,  mortality
Humans
Injury Severity Score
Intracranial Hemorrhages / diagnosis,  drug therapy*,  etiology,  mortality
Logistic Models
Magnetic Resonance Angiography
Male
Middle Aged
Registries
Retrospective Studies
Risk Assessment
Spinal Injuries / complications,  diagnosis,  drug therapy*,  mortality
Stroke / etiology,  mortality,  prevention & control*
Tomography, X-Ray Computed
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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