Blunt carotid injury

Importance of early diagnosis and anticoagulant therapy

Timothy C. Fabian, Joe H. Patton, Martin Croce, Gayle Minard, Kenneth A. Kudsk, F. Elizabeth Pritchard

Research output: Contribution to journalArticle

413 Citations (Scopus)

Abstract

Objective: The incidence, associated injury pattern, diagnostic factors, risk for adverse outcome, and efficacy of anticoagulant therapy in the setting of blunt carotid injury (BCI) were evaluated. Summary Background Data: Blunt carotid injury is considered uncommon. The authors believe that it is underdiagnosed. Outcome is thought to be compromised by diagnostic delay. If delay in diagnosis is important, it is implied that therapy is effective. Although anticoagulation is the most frequently used therapy, efficacy has not been proven. Methods: Patients with BCI were identified from the registry of a level I trauma center during an 11-year period (ending September 1995). Neurologic examinations and outcomes, brain computed tomography (CT) results, angiographic findings, risk factors, and heparin therapy were evaluated. Results: Sixty seven patients with 87 BCIs were treated. Thirty-four percent were diagnosed by incompatible neurologic and CT findings, 43% by new onset of neurologic deficits, and 23% by physical examination (neck injury, Homer's syndrome). There were 54 intimal dissections, 11 pseudoaneurysms, 17 thromboses, 4 carotid cavernous fistulas, and 1 transected internal carotid artery. Thirty-nine patients had follow up angiograms. Mortality rate was 31%. Of 46 survivors, 63% had good neurologic outcomes, 17% moderate, and 20% bad. Logistic regression analysis demonstrated heparin therapy to be associated independently with survival (p < 0.02) and improvement in neurologic outcome (p < 0.01). Conclusions: Blunt carotid injury is more common than appreciated, seen in 0.67% of patients admitted after motor vehicle accidents. Therapy with heparin is highly efficacious, significantly reducing neurologic morbidity and modality. Heparin therapy, when instituted before onset of symptoms, ameliorates neurologic deterioration. Liberal screening, leading to earlier diagnosis, would improve outcome.

Original languageEnglish (US)
Pages (from-to)513-525
Number of pages13
JournalAnnals of Surgery
Volume223
Issue number5
DOIs
StatePublished - 1996

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Nonpenetrating Wounds
Anticoagulants
Early Diagnosis
Nervous System
Heparin
Neurologic Manifestations
Therapeutics
Tomography
Carotid Artery Thrombosis
Tunica Intima
Neck Injuries
Trauma Centers
False Aneurysm
Neurologic Examination
Internal Carotid Artery
Motor Vehicles
Physical Examination
Fistula
Accidents
Survivors

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Fabian, T. C., Patton, J. H., Croce, M., Minard, G., Kudsk, K. A., & Pritchard, F. E. (1996). Blunt carotid injury: Importance of early diagnosis and anticoagulant therapy. Annals of Surgery, 223(5), 513-525. https://doi.org/10.1097/00000658-199605000-00007

Blunt carotid injury : Importance of early diagnosis and anticoagulant therapy. / Fabian, Timothy C.; Patton, Joe H.; Croce, Martin; Minard, Gayle; Kudsk, Kenneth A.; Pritchard, F. Elizabeth.

In: Annals of Surgery, Vol. 223, No. 5, 1996, p. 513-525.

Research output: Contribution to journalArticle

Fabian, TC, Patton, JH, Croce, M, Minard, G, Kudsk, KA & Pritchard, FE 1996, 'Blunt carotid injury: Importance of early diagnosis and anticoagulant therapy', Annals of Surgery, vol. 223, no. 5, pp. 513-525. https://doi.org/10.1097/00000658-199605000-00007
Fabian, Timothy C. ; Patton, Joe H. ; Croce, Martin ; Minard, Gayle ; Kudsk, Kenneth A. ; Pritchard, F. Elizabeth. / Blunt carotid injury : Importance of early diagnosis and anticoagulant therapy. In: Annals of Surgery. 1996 ; Vol. 223, No. 5. pp. 513-525.
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abstract = "Objective: The incidence, associated injury pattern, diagnostic factors, risk for adverse outcome, and efficacy of anticoagulant therapy in the setting of blunt carotid injury (BCI) were evaluated. Summary Background Data: Blunt carotid injury is considered uncommon. The authors believe that it is underdiagnosed. Outcome is thought to be compromised by diagnostic delay. If delay in diagnosis is important, it is implied that therapy is effective. Although anticoagulation is the most frequently used therapy, efficacy has not been proven. Methods: Patients with BCI were identified from the registry of a level I trauma center during an 11-year period (ending September 1995). Neurologic examinations and outcomes, brain computed tomography (CT) results, angiographic findings, risk factors, and heparin therapy were evaluated. Results: Sixty seven patients with 87 BCIs were treated. Thirty-four percent were diagnosed by incompatible neurologic and CT findings, 43{\%} by new onset of neurologic deficits, and 23{\%} by physical examination (neck injury, Homer's syndrome). There were 54 intimal dissections, 11 pseudoaneurysms, 17 thromboses, 4 carotid cavernous fistulas, and 1 transected internal carotid artery. Thirty-nine patients had follow up angiograms. Mortality rate was 31{\%}. Of 46 survivors, 63{\%} had good neurologic outcomes, 17{\%} moderate, and 20{\%} bad. Logistic regression analysis demonstrated heparin therapy to be associated independently with survival (p < 0.02) and improvement in neurologic outcome (p < 0.01). Conclusions: Blunt carotid injury is more common than appreciated, seen in 0.67{\%} of patients admitted after motor vehicle accidents. Therapy with heparin is highly efficacious, significantly reducing neurologic morbidity and modality. Heparin therapy, when instituted before onset of symptoms, ameliorates neurologic deterioration. Liberal screening, leading to earlier diagnosis, would improve outcome.",
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