Comparison of conservative and operative treatment for blunt carotid injuries: Analysis of the National Trauma Data Bank
Presented at the annual meeting of the Society for Vascular Surgery, June 11-14, 2009, Denver, Colo.
Received 18 June 2009; accepted 18 October 2009.
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 hospital course and treatment outcomes for patients with BCI who received different interventions.
Methods
BCI and related vascular procedures were identified by ICD-9-CM codes from the National Trauma Data Bank1 using data gathered from 2002 to 2006. Conservative and operative treatment groups were compared by variables of patient demographics, initial assessment in the emergency department (ED), hospital course, and treatment outcomes. Open surgical and endovascular interventions were further compared.
Results
A total of 842 BCI were identified from 1,633,126 discharged blunt trauma patients (0.05%). Of these, 762 (90.5%) were treated conservatively and 80 (9.5%) received operative intervention. No differences in demographics were observed between these treatment groups. On initial assessment, no differences between conservative and operative treatment groups were noted with regard to vital signs, Glasgow coma scale, presence of drugs or alcohol in blood, or Trauma Related Injury Severity Score survival probability. Significant differences were seen in terms of the presence of a base deficit (−3.1 ± 6.8 vs −7.6 ± 8.3; P = .01), likelihood of a positive head computed tomography (CT) scan (58.6% vs 26.1%; P = .003), and total Injury Severity Score (29.8 ± 13.3 vs 26.1 ± 14.1; P = .02). Hospital course and treatment outcomes were comparable, with no differences in hospital length of stay (13.4 ± 15.3 days vs 13.7 ± 13.6 days; P = .86), total Functional Independence Measure (8.8 ± 3.3 vs 9.3 ± 3.1; P = .38), progression of original neurologic insult (7.5% vs 4.6%; P = .61) or mortality (28.1% vs 19%; P = .08). When comparing open surgical to endovascular interventions (46 open, 34 endovascular, including 3 combined), the only significant differences were in the total Injury Severity Score (22.4 ± 12.2 vs 31.4 ± 15.4; P = .01) and length of intensive care unit (ICU) and hospital stay (5.0 ± 6.0 days vs 10.7 ± 10.4 days; P = .01, and 10.3 ± 9.2 days vs 19.3 ± 17.7 days; P = .01). Multivariate regression analysis confirmed that neither Functional Independence Measure (FIM) nor mortality was associated with conservative or operative treatment.
Conclusion
BCI is rare and carries a poor prognosis. Operative intervention is not associated with functional improvement or a survival advantage. This study was unable to support that less invasive endovascular treatment improves treatment outcome when compared to open surgery.
aDepartment of Surgery, New York Methodist Hospital, Brooklyn, NY
bKings County Hospital Center, SUNY Downstate Medical Center, Brooklyn, NY
Reprint requests: Marcus D'Ayala, MD, Department of Surgery, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215
Competition of interest: none.
Disclaimer: Committee on Trauma, American College of Surgeons, NTDB Version 7.1, Chicago, Ill, 2009. The content reproduced from the NTDB remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original data, text, tables, or figures.
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The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.
ABSTRACT