THE UNRECOGNIZED EPIDEMIC OF BLUNT CAROTID ARTERIAL INJURIES - EARLY DIAGNOSIS IMPROVES NEUROLOGIC OUTCOME

Objective To determine the benefit of screening for blunt carotid arte rial injuries (BCl) in patients who are asymptomatic. Summary Backgrou nd Data Blunt carotid arterial injuries have the potential for devasta ting complications, Published studies report 23% to 28% mortality rate s, with 48% to 58% of survivors having permanent severe neurologic def icits. Most patients have neurologic deficits when the injury is diagn osed. The authors hypothesized that screening patients who are asympto matic and instituting early therapy would improve neurologic outcome. Methods The Trauma Registry of the author's Level I Trauma Center iden tified patients with BCl from 1990 through 1997; Beginning in August 1 996, the authors implemented a screening for BCl, Arteriography was us ed for diagnosis, Patients without specific contraindications were ant icoagulated. Endovascular stents were deployed in the setting of pseud oaneurysms. Results Thirty-seven patients with BCl were identified amo ng 15,331 blunt-trauma victims (0.24%). During the screening period, 2 5 patients were diagnosed with BCl among 2902 admissions (0.86%); 13 ( 52%) were asymptomatic. Overall, eight patients died, and seven of the survivors had permanent severe neurologic deficits. Excluding those d ying of massive brain injury and patients admitted with coma and brain injury, mortality associated with BCl was 15%, with severe neurologic morbidity in 16% of survivors. The patients who were asymptomatic at diagnosis had a better neurologic outcome than those who were symptoma tic. Symptomatic patients who were anticoagulated showed a trend towar d greater neurologic improvement at the time of discharge than those w ho were not anticoagulated, Conclusions Screening allows the identific ation of asymptomatic BCl and thereby facilitates early systemic antic oagulation; which is associated with improved neurologic outcome, The role of endovascular stents in the treatment of blunt traumatic pseudo aneurysms remains to be defined.