Optimal Timing of Operative Intervention for High-grade Carotid Injuries in Patients with Blunt Trauma: A Nationwide Analysis of Trauma Quality Improvement Program

Author Type(s)

Faculty, Resident/Fellow

Document Type

Abstract

Publication Date

2022

DOI

10.1016/j.jvs.2022.03.781

Journal Title

Journal of Vascular Surgery

Department

Surgery

Abstract

Objectives: Blunt carotid injuries (BCIs) are rare injuries with an incidence of 1% to 3% in patients with blunt trauma. Earlier diagnosis and treatment are necessary to prevent the morbidity associated with BCIs. Operative intervention (open or endovascular) is indicated for patients with high-grade BCIs. However, there are no guidelines regarding the timing of operative intervention. The aim of our study was to assess the impact of early vs late operative intervention for BCIs. Methods: We performed a 3-year (2015-2017) analysis of the American College of Surgeons Trauma Quality Improvement Program (TQIP) database and included all adult trauma patients(age ≥17 years) with BCI who underwent operative intervention. Patients were divided into two groups based on the timing of operative intervention: early (≤24 hours from presentation) and late (>24 hours from presentation). We extracted data regarding patient demographics, admission vitals, injury parameters, type of operative intervention, hospital course, and discharge disposition. Outcomes were rates of stroke, mortality, and discharge disposition to home. Multivariate regression analysis was performed to control for confounding variables. Results: We identified 9754 patients with BCI, of whom 517 (5.3%) patients underwent operative intervention for BCI and were included in our analysis. Interventions were most often endovascular (66%; n = 341). The median time to intervention was 21 hours (interquartile range, 5-39 hours). Sixty-three percent of the patients underwent early operative intervention, whereas 37% of the patients had intervention after 24 hours of presentation. Overall, in-hospital stroke rate was 7.1%; the overall mortality was 11%. On comparison of the early vs late intervention groups, patients who underwent early intervention had lower rates of stroke vs those in the late intervention group (4% vs 12.5%; P <.01); additionally, patients in the early intervention group were more likely to be discharged home vs patients who had late operative intervention (47% vs 36%; P =.01). There was no difference between the two groups in terms of mortality (10.8% vs 11.4%; P =.17). On regression analysis when controlled for confounding variables, an early operative intervention was independently associated with lower odds of in-hospital stroke and higher odds of discharge to home. There was no association between the timing of intervention and mortality (Table). Conclusions: Early operative intervention for blunt carotid injuries is associated with decreased rates of in-hospital stroke and higher rates of favorable disposition to home. There was no association between the timing of intervention and mortality. The operative intervention for high-grade BCI should be performed within 24 hours of presentation to reduce the risk of stroke in this high-risk patient population. [Formula presented]

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