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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 1/2021

Open Access 01-02-2021 | Stroke | Original Article

Blunt cerebrovascular injury: incidence and long-term follow-up

Authors: Dennis Hundersmarck, Willem-Bart M. Slooff, Jelle F. Homans, Quirine M. J. van der Vliet, Nizar Moayeri, Falco Hietbrink, Gert J. de Borst, Fetullah Cumhur Öner, Sander P. J. Muijs, Luke P. H. Leenen

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2021

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Abstract

Purpose

Blunt cerebrovascular injuries (BCVI), which can result in ischemic stroke, are identified in 1–2% of all blunt trauma patients. Computed tomography angiography (CTA) scanning has improved and is the diagnostic modality of choice in BCVI suspected patients. Data about long-term functional outcomes and the incidence of ischemic stroke after BCVI are limited. The aim of this study was to determine BCVI incidence in relation to imaging modality improvements and to determine long-term functional outcomes.

Methods

All consecutive trauma patients from 2007 to 2016 with BCVI were identified from the level 1 trauma center prospective trauma database. Three periods were identified where CTA diagnostic modalities for trauma patients were improved. Long-term functional outcomes using the EuroQol six-dimensional (EQ-6D™) were determined.

Results

Seventy-one BCVI patients were identified among the 12.122 (0.59%) blunt trauma patients. In the first period BCVI incidence among the overall study cohort, polytrauma, basilar skull fracture and cervical trauma subgroups was found to be 0.3%, 0.9%, 1.2%, 4.6%, respectively, which more than doubled towards the third period (0.8, 2.4, 1.9 and 8.5% respectively). Ischemic stroke as a result of BCVI was found in 20 patients (28%). In-hospital stroke rate was lower in patients receiving antiplatelet therapy (p < 0.01). Six in-hospital deaths were BCVI related. Long-term follow-up (follow-up rate of 83%) demonstrated lower functional outcomes compared to Dutch reference populations (p < 0.01). Ischemic stroke was identified as a major cause of functional impairment at long-term follow-up.

Conclusions

Improved CTA diagnostic modalities have increased BCVI incidence. Furthermore, BCVI patients reported significant functional impairment at long-term follow-up. Antiplatelet therapy showed a significant effect on in-hospital stroke rate reduction.
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Metadata
Title
Blunt cerebrovascular injury: incidence and long-term follow-up
Authors
Dennis Hundersmarck
Willem-Bart M. Slooff
Jelle F. Homans
Quirine M. J. van der Vliet
Nizar Moayeri
Falco Hietbrink
Gert J. de Borst
Fetullah Cumhur Öner
Sander P. J. Muijs
Luke P. H. Leenen
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 1/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-019-01171-9

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