The high morbidity of blunt cerebrovascular injury in an unscreened population: More evidence of the need for mandatory screening protocols

BACKGROUND: Blunt cerebrovascular injuries are rare injuries causing substa ntial morbidity and mortality. The appropriate screening methods and treatm ent options for these injuries are controversial. We examined our experienc e with these injuries at a community Level I Trauma center over a 51 month period. STUDY DESIGN: A retrospective review and analysis was done of all patients with the diagnosis of a blunt cerebrovascular injury during this period. RESULTS: Fourteen patients had blunt carotid injury (0.40%) and three had b lunt vertebral injury (0.09%) out of 3,480 total blunt admissions. The over all incidence of blunt cerebrovascular injury was 0.49%. The most common as sociated injuries were to the head (59%) and chest (47%) regions. The overa ll mortality rate was 59% (10 of 17), with death occurring in 8 of 14 (57%) blunt carotid injury patients and 2 of 3 (67%) blunt vertebral injury pati ents. Eight of ten (80%) deaths were directly attributable to the blunt cer ebrovascular injury. Median time until diagnosis was 12.5 h (range 1-336 h) for the entire group and 19.5 h for nonsurvivors. Diagnosis was delayed >2 4h in 7 patients and >48h in 5 patients. All five patients whose diagnoses were delayed >48 h developed complications, and four (80%) of these patient s died. CONCLUSIONS: Blunt cerebrovascular injury is uncommon, but lethal; particularly when the diagnosis is delayed. Aggressive screening protocols based on mechanism of injury, associated injuries, and physical findings ar e justified to minimize morbidity and mortality. Head and chest injuries ma y serve as markers for blunt cerebrovascular injury. Most deaths are direct ly attributable to the blunt cerebrovascular injury and not to associated i njuries. (J Am Coll Surg 2001;192:314-321. (C) 2001 by the American College of Surgeons).