OBJECTIVE Blunt traumatic extracranial carotid or vertebral artery injury (i.e., traumatic cerebrovascular injury [TCVI]) occurs in 1%-2% of all blunt trauma admissions, carries a 10% risk of thromboembolic ischemic stroke, and accounts for up to 9600 strokes annually in the US. Screening CT angiograms (CTAs) of patients with trauma has become ubiquitous in recent years, and patients with initially asymptomatic TCVI are commonly treated with antiplatelet agents to prevent stroke. Prophylaxis with antiplatelets is thought to be safer than anticoagulation, which carries a significant risk of hemorrhage in patients with trauma. However, the risk of hemorrhagic complications due to antiplatelets has not been assessed in this population. METHODS This is a retrospective cohort study of patients in whom a screening CTA was obtained after admission for blunt trauma at a Level 1 trauma center. Patients with CTAs indicating TCVI were treated routinely with 325 mg aspirin daily. The risk of transfusion > 24 hours after admission was compared according to CTA findings (CTA+ or CTA- for positive or negative findings, respectively) and aspirin treatment (ASA+ or ASA- for treatment or no treatment, respectively). RESULTS The mean overall transfusion amount (number of units of packed red blood cells [PRBCs]) was 0.9 ± 2.1 for CTA+/ASA+ patients (n = 196) and 0.3 ± 1.60 for CTA-/ASA- patients (n = 2290) (p < 0.0001). In adjusted models, the overall relative risk (RR) of PRBC transfusion was 1.70 (1.32-2.20) for CTA+/ASA+ patients compared with CTA-/ASA- patients. Among age groups, participants whose ages were 50-69 years had the greatest significantly elevated RR (1.71, 95% CI 1.08-2.72) for CTA+/ASA+ patients compared with CTA-/ASA- patients. CONCLUSIONS Treatment with aspirin for the prevention of stroke in patients with initially asymptomatic TCVI carries a significantly increased risk of PRBC transfusion. Future studies are needed to determine if this risk is offset by a reduced risk of ischemic stroke.

Objectives To evaluate “Stop the Bleed” (STB) training among/K12 personnel in an Alabama school system, and to assess participants’ perceived readiness to train peers in STB methods. Design and Sample We performed a cross‐sectional observational study with a convenience, nonprobability sample of 466 full‐time personnel who received STB training. Data were collected using an anonymous online survey. Measurements We asked participants to recall feelings related to STB both prior to and after completing training using a 5‐point Likert scale (5 = “Strongly Disagree”, 1 = “Strongly Agree”). We used logistic regression to evaluate the association among posttraining feelings and perceived preparedness to train others in STB. Results Participants were primarily female (78%), aged 41 ± 10 years, who held faculty positions (94%). Results revealed increased knowledge of (4 [IQR 2–4] vs. 2 [1–2], p < .001) and comfort with (4 [2–5] vs. 2 [1–2], p < .001) STB skills. Participants felt more empowered to organize STB training (4 [3–5] vs. 3 [2–4], p < .001); those who felt empowered to organize STB training were eight times more likely to feel capable of teaching STB. Conclusions After STB training, K‐12 personnel felt empowered to organize additional STB trainings and capable of teaching STB methods to others.

RESEARCH BACKGROUNDWorldwide, trauma or unintentional injury claims an estimated 8% of deaths (World Health Organization, 2021). In the United States alone, trauma is the fourth leading cause of death for people of all ages (Ahmad et al., 2021;Kochanek et al., 2020). Of those who experience critical injury, uncontrolled hemorrhage accounts for 35% of all deaths prior to hospitalization