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Home > Vascular Annual Meeting^® > RR34. Comparison of Conservative and Operative...

RR34. Comparison of Conservative and Operative Interventions After Blunt Carotid Injuries: Analysis of the National Trauma Data Bank

Wei Li1, Marcus D'Ayala1, William Briggs1, Asher Hirshberg2, Patricia A. O’Neill2, Leslie Wise1, Anthony J. Tortolani1
1Department of Surgery, New York Methodist Hospital, Affiliate: Weill Medical College of Cornell University, Brooklyn, NY; 2Trauma Service, Kings County Hospital Center, SUNY Downstate Medical Center, Brooklyn, NY

OBJECTIVES: Blunt carotid injury (BCI) is uncommon but potentially devastating. The best treatment modality for this injury remains undetermined. We conducted this study to better understand the demographics, hospital course, and treatment outcomes for patients with BCI who received different interventions.
METHODS: BCI and related vascular procedures were identified by ICD-9 codes from the National Trauma Data Bank (NTDB) using data gathered from 2002 to 2006. Conservative and operative treatment groups were compared by variables of patient demographics, initial assessment in the ED, hospital course, and treatment outcomes. Open surgical and endovascular interventions were further compared.

RESULTS: A total of 842 BCI were identified from 1,926,245 discharged trauma incidents (0.04%). Of these, 762 (90.5%) patients were treated conservatively and 80 (9.5%) received operative intervention. No differences in demographics were observed between these treatment groups. Average age was 35 years, 65% were male, and 75% were white. On initial assessment, no differences between conservative and operative treatment groups were noted with regards to vital signs, Glasgow coma scale, presence of drugs or alcohol in blood, or Trauma Related Injury Severity Score (TRISS) survival probability. Significant differences were seen in terms of the likelihood of a positive head CT (59% vs. 27%), presence of a base deficit (-3.1 vs. -7.6), and total injury severity score (30 vs. 26). Hospital course and treatment outcomes were comparable, with no significant differences in hospital length of stay, Functional Independence Measure (FIM), or mortality. When comparing open surgical to endovascular interventions (47 open, 30 endovascular, 3 combined), the only significant differences were in total injury severity score (22 vs. 31) and length of ICU and hospital stay (5 vs. 11, and 10 vs. 19 days). Multivariate regression analysis confirmed that neither FIM nor mortality was associated with conservative or operative treatment.

CONCLUSIONS: BCI is rare. It is most commonly seen in young males and carries a poor prognosis. Operative intervention is not associated with functional improvement or survival advantage. Less invasive endovascular treatment does not appear to improve treatment outcomes when compared with open surgery.

AUTHOR DISCLOSURES: W. Li, None; M. D'Ayala, None; W. Briggs, None; A. Hirshberg, None; P.A. O’Neill, None; L. Wise, None; A.J. Tortolani, None.