Long-Term Functional Outcomes after Blunt Cerebrovascular Injury: A 20-Year Experience

Abstract

Since blunt cerebrovascular injury (BCVI) became increasingly recognized more than 20 years ago, significant improvements have been made in both diagnosis and treatment. Little is known regarding long-term functional outcomes in BCVI. The purpose of this study was to evaluate the impact of BCVI on those long-term outcomes. All patients with BCVI from 1996 to 2014 were identified from the trauma registry. Functional outcome was measured using the Boston University Activity Measure for Post-Acute Care. Multiple regression analysis was performed to identify potential predictors of outcomes. A total of 509 patients were identified. Overall mortality was 18 per cent (BCVI-related = 1%). Of the 415 survivors, follow-up was obtained in 77 (19%). Mean follow-up was five years, with a maximum of 19 years. Mean age and injury severity score were 47 and 25, respectively. Six (8%) patients suffered strokes. Mean Activity Measure for Post-Acute Care scores were 59 (mobility), 58 (activity), and 44 (cognitive function), each indicating significant impairment compared with normal. Multiple regression models identified 1) age as a predictor of decreased mobility, 2) injury severity score as a predictor of decreased mobility, activity, and cognitive function, and 3) stroke as a predictor of decreased activity, cognitive function, and likely mobility. Development of stroke and increased injury severity resulted in worse long-term functional outcomes after BCVI. Thus, stroke prevention with optimal diagnostic and treatment algorithms remains critical in the successful treatment of BCVI because it has significant impact on long-term functional outcomes and is the only modifiable predictor of outcomes in patients after BCVI.

Antithrombotic choice in blunt cerebrovascular injuries: Experience at a tertiary trauma center, systematic review, and meta-analysis

“…66 Previous studies have demonstrated the importance of stroke prevention as a key factor in improving long-term functional outcomes following BCVI, but optimal antithrombotic choice remains unknown. 48,67,68 In our systematic review and meta-analysis, we similarly found that the ischemic stroke rate in previously asymptomatic patients was not significantly different between AP versus anticoagulation treatment. Direct meta-analysis comparison between the untreated patients versus patients treated with any antithrombotic was not performed because multiple studies have already confirmed the benefit of antithrombotic treatment, and our systematic review was not designed to capture these studies.…”

“…Antiplatelet drug resistance or lack of response to agents such as aspirin or clopidogrel may be detected by platelet function testing and has been shown to predict an increased risk of ischemic events while on AP treatment 66 . Previous studies have demonstrated the importance of stroke prevention as a key factor in improving long-term functional outcomes following BCVI, but optimal antithrombotic choice remains unknown 48,67,68 …”

Early Pharmacologic Therapy in Patients With Blunt Cerebrovascular Injury and TBI: Is it Safe and Effective? An EAST Multicenter Study

“…1 While the injury is rare, 2-4 resulting stroke can have devastating consequences for the patient. 5 BCVI is treated with antithrombotic or anticoagulant therapy, which have been shown to decrease stroke rates in patients with BCVI. 3,4,6-12 However, BCVI in the setting of TBI is challenging as there is concern for hemorrhagic progression with BCVI treatment.…”

Different strokes: differences in the characteristics and outcomes of BCVI and non-BCVI strokes in trauma patients

“…Shahan et al demonstrated that stroke, along with age, predicts decreased mobility after BCVI and that the occurrence of stroke predicts decreased activity and cognitive function. 17 Given the association of BCVIs with traumatic brain injury, functional and cognitive impairment may be further exacerbated in the elderly in whom falls are common.…”