BLUNT CAROTID INJURY - IMPORTANCE OF EARLY DIAGNOSIS AND ANTICOAGULANT-THERAPY

Objective The incidence, associated injury pattern, diagnostic factors , risk for adverse outcome, and efficacy of anticoagulant therapy in t he setting of blunt carotid injury (BCl) were evaluated. Summary Backg round Data Blunt carotid injury is considered uncommon. The authors be lieve that it is underdiagnosed. Outcome is thought to be compromised by diagnostic delay. If delay in diagnosis is important, it is implied that therapy is effective. Although anticoagulation is the most frequ ently used therapy, efficacy has not been proven. Methods Patients wit h BCI were identified from the registry of a level I trauma center dur ing an 11-year period (ending September 1995). Neurologic examinations and outcomes, brain computed tomography (CT) results, angiographic fi ndings, risk factors, and heparin therapy were evaluated. Results Sixt y-seven patients with 87 BCls were treated. Thirty-four percent were d iagnosed by incompatible neurologic and CT findings, 43% by new onset of neurologic deficits, and 23% by physical examination (neck injury, Horner's syndrome). There were 54 intimal dissections, 11 pseudoaneury sms, 17 thromboses, 4 carotid cavernous fistulas, and 1 transected int ernal carotid artery. Thirty-nine patients had follow-up angiograms. M ortality rate was 31%. Of 46 survivors, 63% had good neurologic outcom es, 17% moderate, and 20% bad. Logistic regression analysis demonstrat ed heparin therapy to be associated independently with survival (p < 0 .02) and improvement in neurologic outcome (p < 0.01). Conclusions Blu nt carotid injury is more common than appreciated, seen in 0.67% of pa tients admitted after motor vehicle accidents. Therapy with heparin is highly efficacious, significantly reducing neurologic morbidity and m ortality. Heparin therapy, when instituted before onset of-symptoms, a meliorates neurologic deterioration. Liberal screening, leading to ear lier diagnosis, would improve outcome.