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Blunt Cerebrovascular Injury in Trauma-Fixed or Modifiable Risk Factor for Stroke?
Steven G Schauer1, Michael D April2, Andrew D Fisher3
1US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas; Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas; Center for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Aurora, Colorado.
Insights
Blunt cerebrovascular injury (BCVI) is associated with higher stroke risk. Current treatments like anticoagulation or antiplatelet therapy show no significant benefit in preventing stroke in BCVI patients.
Area of Science:
- Trauma Surgery
- Neurology
- Epidemiology
Background:
- Blunt cerebrovascular injury (BCVI) epidemiology and treatment outcomes lack consistent findings.
- Analysis of the Trauma Quality Improvement Program registry aimed to clarify BCVI epidemiology and outcomes.
Purpose of the Study:
- To describe the epidemiology of blunt cerebrovascular injury (BCVI).
- To evaluate outcomes associated with current treatment strategies for BCVI.
Main Methods:
- Analysis of patients aged ≥15 years with blunt mechanism trauma from 2017-2023.
- Classification of BCVI into low-grade (1-2) and high-grade (3-5).
- Comparison of stroke incidence and risk factors between patients with and without BCVI, and across different treatment strategies.
Main Results:
- Over 5.7 million patients analyzed; 53,940 had documented BCVI.
- BCVI patients had a significantly higher stroke incidence (3.3%) compared to non-BCVI patients (0.2%).
- Unadjusted and adjusted analyses indicated no significant stroke risk reduction with heparin, low-molecular-weight heparin, or aspirin compared to no prophylaxis for both low- and high-grade BCVI.
Conclusions:
- Current anticoagulation and antiplatelet therapies do not demonstrate a benefit in reducing stroke risk for BCVI patients.
- The findings question whether stroke in BCVI is a modifiable event.
- High-quality clinical trials are necessary to establish effective treatment strategies for BCVI.
Introduction:
The epidemiology of blunt cerebrovascular injury (BCVI) lacks consistent findings. We sought to describe the epidemiology of BCVI and the outcomes associated with current treatment strategies within the Trauma Quality Improvement Program registry.
Methods:
We analyzed data from patients ≥15 years of age with a blunt mechanism. BCVI was classified as low grade (1-2) and high grade (3-5).
Results:
From 2017 to 2023, there were 5,798,774 patients that met inclusion. There were 53,940 had a documented BCVI, of which 36,183 were low grade and 19,747 were high grade. Among those without a BCVI, the incidence of stroke was 0.2% (n = 13,459, 95% confidence interval [CI] 0.2-0.2) compared to those with BCVI 3.3% (n = 1763, CI 3.1-3.4). Among those with a BCVI, those with stroke had a higher median composite injury severity score (29, 20-38 versus 20, 12-29, P < 0.001). Unadjusted stroke risk was as follows based on receipt versus nonreceipt: heparin (5% versus 3%, P < 0.001), low-molecular weight heparin (3% versus 3%, P = 0.080), aspirin (4% versus 3%, P = 0.077), and none (2% versus 4%, P < 0.001). Among those with low-grade BCVI, after adjusting for age, sex, injury severity score, and comorbidities, and mechanism of injury, the following associations with stroke: heparin (odds ratio 2.01, 95% CI 1.30-3.08), LWMH (1.12, 0.73-1.72), aspirin (1.67, 1.01-2.78), and no prophylaxis (0.63, 0.40-0.99). For high-grade: heparin (1.71, 1.13-2.59), LMHW (1.15, 0.76-1.73), aspirin (1.74, 1.06-2.86), and none (0.60, 0.39-0.92).
Conclusions:
Unadjusted and adjusted stroke risk between those with and without anticoagulation or antiplatelet therapy demonstrated no benefit. Our findings call into question whether stroke is a modifiable event. High-quality trials are needed.
