Evaluation of the criteria for angiotomography indications in the diagnosis of carotid and vertebral arterial injury associated with blunt trauma
نویسندگان
چکیده
BACKGROUND Blunt carotid and vertebral artery injury (BCVI) occur infrequently. The incidence of this type of injury is difficult to determine as many emergency room patients are neurologically asymptomatic. The statistics have not been reported in Brazil. The objectives of the current study were: To evaluate the accuracy of criteria used to recommend angiotomography in the diagnosis of cervical BCVI in 100 patients with blunt cervical trauma in the trauma services section of a Brazilian quaternary care hospital. METHODS During a 30-month (2006-2008), all patients admitted to the emergency room of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo with blunt cervical trauma and potential risk of cervical vessel injury, were subjected to cervical angiotomography to diagnose BCVI. The data analyzed are presented as mean +/- standard deviation, and statistical analyses included Chi-square and Fisher's exact tests, and the Mann-Whitney test. RESULTS During the study period 2467 blunt trauma patients were admitted. In 100 patients that met the criteria for inclusion in the study, angiotomography identified 23 with BCVI, including 17 males and six females. The mean patient age was 34.81 +/- 14.84 years. Car crash (49%) and car-pedestrian accidents (24%) were the most frequent causes of injury. Ten patients had internal carotid artery injuries, two patients had common carotid artery injuries, and 11 patients had vertebral artery injuries. Seven patients presented with Degree I arterial injuries, 10 patients presented with Degree II artery injuries, four patients presented with Degree IV artery injuries, one patient presented with a Degree V artery injury, and one patient had a carotid fistula. Seven out of the 23 patients with BCVI (30.4%) presented with cervical vertebrae fractures, and 11 out of the 23 patients with BCVI (47.8%) presented with facial fractures (LeFort II and III). CONCLUSIONS Although there is no consensus regarding the criteria that should be used to indicate angiotomography for BCVI diagnosis, we conclude that the criteria used in the current study led to a diagnosis of BCVI in 0.93% of 2,467 trauma patients, BCVI injuries were associated with more severe traumas and did not affect mortality.
منابع مشابه
MRI findings in patients with blunt cervical trauma having a normal level of consciousness and normal CT reports
Objective: This study investigates the possible magnetic resonance imaging (MRI) findings in patients with cervical trauma having a normal level of consciousness and normal CT reports. These patients have tenderness or an uncomfortable feeling in the traumatized area as well.Methods: In this cross-sectional anterograde study, cases were selected among patients referred to the emergency de...
متن کاملEvaluation of PERSH Criteria to Avoid Unnecessary Chest X-ray in Patients with Blunt Chest Trauma: A Qualitative Study
Background: Chest X-rays (CXRs) are traditionally performed to determine intra-thoracic injuries in all blunt chest trauma patients in Shahid Bahonar hospital in Kerman. As there are some disadvantages upon CXR and radiation exposure, therefore, this study aimed to evaluate the role of CXR in the diagnosis of intra-thoracic injuries caused by any blunt chest trauma. Me...
متن کاملScreening for blunt cerebrovascular injuries is cost-effective.
BACKGROUND Recent reports have argued that screening for blunt carotid injury is futile and have called for a cost analysis. Our data previously supported screening asymptomatic trauma patients for blunt cerebrovascular injury (BCVI) to prevent associated neurologic sequelae. Our hypothesis is that aggressive angiographic screening for BCVI based on a patient's injury pattern and symptoms allow...
متن کاملBlunt vertebral vascular injury in trauma patients: ATLS® recommendations and review of current evidence.
Blunt cerebrovascular injury (BCVI) encompasses two distinct clinical entities: traumatic carotid artery injury (TCAI) and traumatic vertebral artery injury (TVAI). The latter is the focus of our review. These are potentially devastating injuries which pose a diagnostic challenge in the acute trauma setting. There is still debate regarding the optimal screening criteria, diagnostic imaging moda...
متن کاملایسکمی تأخیری مغزی بدنبال ترمیم ترومای نافذ شریان کاروتید خارجی
Introduction: Penetrating trauma to anterior neck can induce cerebral ischemia due to carotid artery injury. Brain ischemia also can present after surgical carotid repairs. Early diagnosis and suitable treatment modality prevent from permanent neurologic deficit post operatively. Case Report: A 30 years old man with stab wound to zone two left side of neck underwent exploration and penrose i...
متن کامل