Camille Hego1, Guillaume Rousseau2, Paer-Selim Abback2, Romain Pommier3, Sophie-Rym Hamada4,5, Benjamin Bergis4,5, Igor Jurcisin2, Alhassane Diallo6, Catherine Paugam-Burtz2,7, Stéphanie Sigaut2, Tobias Gauss2, Jean-Denis Moyer2. 1. Department of Anesthesiology and Critical Care and Perioperative Care, Beaujon Hospital, 100, boulevard du Général-Leclerc, 92110, Clichy, France. camille.hego@aphp.fr. 2. Department of Anesthesiology and Critical Care and Perioperative Care, Beaujon Hospital, 100, boulevard du Général-Leclerc, 92110, Clichy, France. 3. Department of Radiology, Antony's Private Hospital, 25 Avenue de la Providence, 92160, Antony, France. 4. Department of Anesthesiology and Critical Care, 75 rue du general Leclerc, 94275, Le Kremlin Bicêtre, France. 5. University of Paris Saclay, 63 rue Gabriel Péri, 94270, Le Kremlin-Bicêtre, France. 6. Department of Epidemiology and Clinical Research of Bichat Hospital, 46 Rue Henri Huchard, 75018, Paris, France. 7. University of Medicine Paris VII Denis-Diderot, 16 Rue Henri Huchard, 75018, Paris, France.
Abstract
PURPOSE: Blunt cerebrovascular injuries (BCVI) are a rare but serious complication after trauma. Among patients with BCVI, neurological status is altered in 30% of cases and the prognosis seems to be associated with ischemic complications. The aim of this study was to assess the long-term outcome of BCVI-associated ischemic events. METHODS: This retrospective cohort study (2011-2017) included all patients admitted for severe trauma with identified BCVI in two level-1 trauma centers. Patients were considered to have a poor neurological outcome with a GOS-E between 2 and 5 and a good neurological outcome with GOS-E between 6 and 8. A multivariate logistic regression identified risk factors for poor neurological outcome at 1 year. RESULTS: Of the 6,294 patients admitted in both trauma centers between 2011 and 2017, 81 patients presenting BCVI were identified (incidence of 1.3%). The median age was 35 years (24-44) with a median Injury Severity Score of 28 (17-41). 29 patients (50%) had a good neurological prognosis, while 25 patients (43%) had a poor neurological prognosis at 1 year. Ischemic stroke occurred in 11 patients (13.6%) within a median time of 2 days (2-2.5). No ischemic stroke occurred in the first year after ICU discharge in both groups. In our study, good prognosis at 1 year was not associated with ischemic complications [3 (10) vs 3 (12) p = 1]. CONCLUSION: Ischemic complications after BCVI are rare, occur within the first week and do not seem to impact independently the 1-year neurological prognosis.
PURPOSE: Blunt cerebrovascular injuries (BCVI) are a rare but serious complication after trauma. Among patients with BCVI, neurological status is altered in 30% of cases and the prognosis seems to be associated with ischemic complications. The aim of this study was to assess the long-term outcome of BCVI-associated ischemic events. METHODS: This retrospective cohort study (2011-2017) included all patients admitted for severe trauma with identified BCVI in two level-1 trauma centers. Patients were considered to have a poor neurological outcome with a GOS-E between 2 and 5 and a good neurological outcome with GOS-E between 6 and 8. A multivariate logistic regression identified risk factors for poor neurological outcome at 1 year. RESULTS: Of the 6,294 patients admitted in both trauma centers between 2011 and 2017, 81 patients presenting BCVI were identified (incidence of 1.3%). The median age was 35 years (24-44) with a median Injury Severity Score of 28 (17-41). 29 patients (50%) had a good neurological prognosis, while 25 patients (43%) had a poor neurological prognosis at 1 year. Ischemic stroke occurred in 11 patients (13.6%) within a median time of 2 days (2-2.5). No ischemic stroke occurred in the first year after ICU discharge in both groups. In our study, good prognosis at 1 year was not associated with ischemic complications [3 (10) vs 3 (12) p = 1]. CONCLUSION: Ischemic complications after BCVI are rare, occur within the first week and do not seem to impact independently the 1-year neurological prognosis.
Authors: Marc D Trust; Jacob Veith; Carlos V R Brown; John P Sharpe; Tashinga Musonza; John Holcomb; Eric Bui; Brandon Bruns; H Andrew Hopper; Michael Truitt; Clay Burlew; Morgan Schellenberg; Jack Sava; John Vanhorn; Brian Eastridge; Alicia M Cross; Richard Vasak; Gary Vercuysse; Eleanor E Curtis; James Haan; Raul Coimbra; Phillip Bohan; Stephen Gale; Peter G Bendix Journal: J Trauma Acute Care Surg Date: 2018-12 Impact factor: 3.313
Authors: Jeffrey D Crawford; Kevin M Allan; Karishma U Patel; Kyle D Hart; Martin A Schreiber; Amir F Azarbal; Timothy K Liem; Erica L Mitchell; Gregory L Moneta; Gregory J Landry Journal: JAMA Surg Date: 2015-09 Impact factor: 14.766