The Journal of surgical research · 2025
Evaluating Clinical Outcomes and Management Strategies for Isolated Blunt Cerebrovascular Injury in Adult Trauma Patients: A Nationwide Cohort Study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Espat Nikita Nunes, Lee Philip, Hernandez Nickolas, Oconnor Brevin, Rogers Logan, Kumar Sarthak, Chin Brian, Elkbuli Adel
Аннотация
INTRODUCTION: This study aims to compare the outcomes of endovascular repair to nonoperative and operative options in the treatment of moderate-to-severe blunt cerebrovascular injury (BCVIs) in adult trauma patients.
METHODS: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Program Participant Use File database from 2017 to 2021. Adult (age ≥ 18 y) trauma patients with moderate-to-severe (injury severity score ≥ 9) blunt injuries and severe isolated (abbreviated injury scale head and neck ≥ 3, all other regions ≤ 2) BCVI were included. The primary outcome was the incidence of ischemic stroke. Secondary outcomes included mortality rates, intensive care unit length of stay, ventilator-free days, and discharge disposition.
RESULTS: A total of 3521 adult trauma patients with isolated BCVI were included, of which 3454 (98.1%) were managed nonoperatively, 21 (0.6%) were managed operatively, and 46 (1.3%) were managed with endovascular repair. There was no significant difference in evaluated outcomes when comparing endovascular repair to nonoperative management. When comparing endovascular repair to operative management, the majority of outcomes were comparable; however, patients treated with endovascular repair experienced significantly more ventilator-free days compared to those managed operatively (β 0.572, 95% confidence interval -1.764 to 2.908, P = 0.002).
CONCLUSIONS: In patients with moderate-to-severe BCVI, endovascular repair outcomes were comparable to both operative and nonoperative management, indicating its viability as a safe treatment option. Further research is needed to identify patient characteristics that influence outcomes and establish clearer evidence for endovascular repair's effectiveness and safety in this population.
METHODS: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Program Participant Use File database from 2017 to 2021. Adult (age ≥ 18 y) trauma patients with moderate-to-severe (injury severity score ≥ 9) blunt injuries and severe isolated (abbreviated injury scale head and neck ≥ 3, all other regions ≤ 2) BCVI were included. The primary outcome was the incidence of ischemic stroke. Secondary outcomes included mortality rates, intensive care unit length of stay, ventilator-free days, and discharge disposition.
RESULTS: A total of 3521 adult trauma patients with isolated BCVI were included, of which 3454 (98.1%) were managed nonoperatively, 21 (0.6%) were managed operatively, and 46 (1.3%) were managed with endovascular repair. There was no significant difference in evaluated outcomes when comparing endovascular repair to nonoperative management. When comparing endovascular repair to operative management, the majority of outcomes were comparable; however, patients treated with endovascular repair experienced significantly more ventilator-free days compared to those managed operatively (β 0.572, 95% confidence interval -1.764 to 2.908, P = 0.002).
CONCLUSIONS: In patients with moderate-to-severe BCVI, endovascular repair outcomes were comparable to both operative and nonoperative management, indicating its viability as a safe treatment option. Further research is needed to identify patient characteristics that influence outcomes and establish clearer evidence for endovascular repair's effectiveness and safety in this population.