Penetrating Injury to the Carotid Artery: Characterizing Presentation and Outcomes from the National Trauma Data Bank.

MedStar author(s):
Citation: Annals of Vascular Surgery. 67:192-199, 2020 Aug.PMID: 32217135Institution: MedStar Union Memorial HospitalDepartment: SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Carotid Artery Injuries/th [Therapy] | *Endovascular Procedures | *Neck Injuries/th [Therapy] | *Vascular Surgical Procedures | *Wounds, Penetrating/th [Therapy] | Adult | Carotid Artery Injuries/dg [Diagnostic Imaging] | Carotid Artery Injuries/mo [Mortality] | Databases, Factual | Endovascular Procedures/ae [Adverse Effects] | Endovascular Procedures/mo [Mortality] | Female | Hospital Mortality | Humans | Injury Severity Score | Male | Neck Injuries/dg [Diagnostic Imaging] | Neck Injuries/mo [Mortality] | Risk Assessment | Risk Factors | Time Factors | Treatment Outcome | United States | Vascular Surgical Procedures/ae [Adverse Effects] | Vascular Surgical Procedures/mo [Mortality] | Wounds, Penetrating/dg [Diagnostic Imaging] | Wounds, Penetrating/mo [Mortality] | Young AdultYear: 2020Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0890-5096
Name of journal: Annals of vascular surgeryAbstract: BACKGROUND: Penetrating injury to the neck can be devastating due to the multiple vital structures in close proximity. In the event of injury to the carotid artery, there is a significantly increased likelihood of morbidity or mortality. The purpose of this study was to assess presenting characteristics associated with penetrating injury to the carotid artery, and directly compare approaches to surgical management.CONCLUSIONS: These results indicate that non-operative patients often present with a more severe overall injury burden, particularly injury to the head, and not surprisingly, have higher rates of mortality. The lack of significant differences in outcomes relating to surgical approach indicates open vs. endovascular invention should be individualized to the patient-e.g., based on presenting characteristics and the location of the injury. Copyright (c) 2020 Elsevier Inc. All rights reserved.METHODS: Data from the National Trauma Data Bank from 2002-2016 was accessed to evaluate adult patients sustaining penetrating injury to the common or internal carotid artery. Management (operative vs. non-operative) and surgical approach (open vs. endovascular) were evaluated based on presentation characteristics; and outcomes were compared after propensity-score matching.RESULTS: 3,391 patients fitting inclusion criteria and surviving past the the emergency department were included in analyses (non-operative: 1,976 [58.3%], operative: 1,415 [41.7%] patients). The operative group was further classified by intervention: open = 1,192, endovascular: 154. On presentation, the non-operative group demonstrated significantly higher prevalence of: coma (Glasgow Coma Scale [GCS] <=8: non-operative = 49.3% vs. operative = 40.8%, P < 0.001), severe overall injury burden (Injury Severity Score [ISS] >=25: non-operative = 42.3% vs. operative = 33.3%, P < 0.001), and severe head injury (Abbreviated Injury Score [AIS] >= 3: non-operative = 44.9% vs. operative = 22.0%, P < 0.001). After propensity-score matching, the non-operative group demonstrated higher mortality (non-operative = 28.9% vs. operative = 18.5%, P < 0.001), and lower rates of stroke (non-operative = 6.6% vs. operative -= 10.5%, P < 0.001). There were no differences in outcomes relating to surgical approach.All authors: Blitzer DN, DuBose JJ, Feliciano DV, Morrison JJ, O'Connor J, Ottochian M, Scalea TMOriginally published: Annals of Vascular Surgery. 2020 Mar 23Fiscal year: FY2021Fiscal year of original publication: FY2020Digital Object Identifier: Date added to catalog: 2020-07-09
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 32217135 Available 32217135

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: Penetrating injury to the neck can be devastating due to the multiple vital structures in close proximity. In the event of injury to the carotid artery, there is a significantly increased likelihood of morbidity or mortality. The purpose of this study was to assess presenting characteristics associated with penetrating injury to the carotid artery, and directly compare approaches to surgical management.

CONCLUSIONS: These results indicate that non-operative patients often present with a more severe overall injury burden, particularly injury to the head, and not surprisingly, have higher rates of mortality. The lack of significant differences in outcomes relating to surgical approach indicates open vs. endovascular invention should be individualized to the patient-e.g., based on presenting characteristics and the location of the injury. Copyright (c) 2020 Elsevier Inc. All rights reserved.

METHODS: Data from the National Trauma Data Bank from 2002-2016 was accessed to evaluate adult patients sustaining penetrating injury to the common or internal carotid artery. Management (operative vs. non-operative) and surgical approach (open vs. endovascular) were evaluated based on presentation characteristics; and outcomes were compared after propensity-score matching.

RESULTS: 3,391 patients fitting inclusion criteria and surviving past the the emergency department were included in analyses (non-operative: 1,976 [58.3%], operative: 1,415 [41.7%] patients). The operative group was further classified by intervention: open = 1,192, endovascular: 154. On presentation, the non-operative group demonstrated significantly higher prevalence of: coma (Glasgow Coma Scale [GCS] <=8: non-operative = 49.3% vs. operative = 40.8%, P < 0.001), severe overall injury burden (Injury Severity Score [ISS] >=25: non-operative = 42.3% vs. operative = 33.3%, P < 0.001), and severe head injury (Abbreviated Injury Score [AIS] >= 3: non-operative = 44.9% vs. operative = 22.0%, P < 0.001). After propensity-score matching, the non-operative group demonstrated higher mortality (non-operative = 28.9% vs. operative = 18.5%, P < 0.001), and lower rates of stroke (non-operative = 6.6% vs. operative -= 10.5%, P < 0.001). There were no differences in outcomes relating to surgical approach.

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