BLUNT CAROTID-ARTERY INJURIES

Background: Blunt carotid artery trauma remains a rare but potentially devastating injury. Early detection and treatment remain the goals of management. Our objective was to identify patients sustaining blunt c arotid injuries at a regional trauma center and report on the incidenc e, demographics, diagnostic workup, management, and outcome. Study Des ign: A retrospective chart review was performed of patients sustaining blunt carotid artery injury. between 1990 and 1996. Results: Twenty p atients were identified during the 7-year period. All patients suffere d blunt trauma, with motor vehicle accidents being the most common mec hanism, and the internal carotid the most frequently injured vessel. A ssociated injuries were present in all patients, with head (65%) or ch est (65%) injuries being the most common. The combination of head and chest trauma (45%) was found to be associated with a 14-fold increase in the likelihood of carotid injury. Cerebral angiography was diagnost ic in all patients and the majority were treated nonoperatively with a nticoagulation. Twenty percent of patients were discharged with a norm al neurologic exam, while 45% left with a significant neurologic defic it. Overall mortality was 5%. Conclusions: Blunt carotid injuries are rare but are associated with significant morbidity and mortality. The combination of craniofacial and chest wounds should raise the index of suspicion for blunt carotid injury. Anticoagulation was associated wi th the least morbidity. (C) 1997 by the American College of Surgeons.