Challenges in Treatment of Low-Grade Blunt Cerebrovascular Injuries at a Safety-net Hospital

Treatment for grade I and II blunt cerebrovascular injuries (BCVIs) involves 3 mo of antiplatelet or anticoagulation therapy with repeat imaging within 7-10 d. We hypothesized that patients at safety-net hospitals often do not complete this regimen, leaving them at risk for cerebrovascular events.

We performed a retrospective review of patients with grade I-II BCVI at a level 1 trauma center (January 2016-July 2024). Data included timing of initial and repeat computed tomography angiography, initiation, duration, and adherence to medical treatment. Outcomes were completion of repeat imaging and 3-mo medical treatment. Univariate and multivariable analyses were conducted to identify factors associated with treatment completion.

Of 286 patients screened, 38 (30 grade I, 8 grade II) were diagnosed with BCVI. Median age was 44 y, 61% were male, and motor vehicle collision was the most common mechanism (39.5%). Repeat imaging was obtained in 23 patients (60.5%) at a median of 6 d (interquartile range 3-13). Medical treatment was initiated in 32 (84.2%), with 27 (71.1%) discharged on treatment; 12 (44%) completed the 3-mo regimen. No patients obtained 7- to 10-d outpatient imaging, and fewer than half had BCVI addressed in follow-up. On univariate analysis, Hispanic ethnicity (Odds Ratio [OR] 15.6, P = 0.02) and BCVI-specific follow-up (OR 15.0, P = 0.01) were associated with treatment completion. In multivariable analysis, BCVI-specific follow-up remained associated (OR 15.8, P = 0.03).

Adherence to guideline-recommended BCVI therapy and follow-up imaging was poor. Structured discharge pathways and linkage to BCVI-specific follow-up may improve treatment completion.