Carotid artery dissection and motor vehicle trauma: patient demographics, associated injuries and impact of treatment on cost and length of stayReport as inadecuate




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BMC Emergency Medicine

, 16:23

Trauma emergency medicine

Abstract

BackgroundBlunt carotid arterial injury BCI is a rare injury associated with motor vehicle collision MVC. There are few population based analyses evaluating carotid injury associated with blunt trauma and their associated injuries as well as outcomes.

MethodsThe Nationwide Inpatient Sample NIS 2003–2010 data was queried to identify patients after MVC who had documented BCI during their hospitalizations utilizing ICD-9-CM codes. Demographics, associated injuries, interventions performed, length of stay, and cost were evaluated.

Results1,686,867 patients were estimated having sustained MVC; 1,168 BCI were estimated. No patients with BCI had open repair, 4.24 % had a carotid artery stent CAS, and 95.76 % of patients had no operative intervention. Age groups associated with BCI were: 18–24 27.8 %, 47–60 22.3 %, 35–46 20.6 %, 25–34 19.1 %, >61 10.2 %. Associated injuries included long bone fractures 28.5 %, stroke and intracranial hemorrhage 28.5 %, cranial injuries 25.6 %, thoracic injuries 23.6 %, cervical fractures 21.8 %, facial fractures 19.9 %, skull fractures 18.8 %, pelvic fractures 18.5 %, hepatic 13.3 % and splenic 9.2 % injuries. Complications included respiratory 44.2 %, bleeding 16.1 %, urinary tract infections 8.9 %, and sepsis 4.9 %. Overall mortality was 14.1 % without differences with regard to intervention 18.5 % vs. 13.9 %; P = 0.36. Stroke and intracranial hemorrhage was associated with a 2.7 times greater risk of mortality. Mean length of stay for patients with BCI undergoing stenting compared to no intervention were similar 13.1 days vs. 15.9 days but had a greater mean cost $83,030 vs. $63,200, p = 0.3.

ConclusionBCI is a rare injury associated with MVC, most frequently reported in younger patients. Frequently associated injuries were long bone fractures, stroke and intracranial hemorrhage, thoracic injuries, and pelvic fractures which are likely associated with the force-mechanism of injury. The majority of patients were treated without intervention, but when CAS was utilized, it did not impact mortality and trended toward increased costs.

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Author: Jared E. Kray - Viktor Y. Dombrovskiy - Todd R. Vogel

Source: https://link.springer.com/







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