Department of Surgery, New York Methodist Hospital, Brooklyn, NY 11215, USA.
J Vasc Surg. 2010 Mar;51(3):593-9, 599.e1-2. doi: 10.1016/j.jvs.2009.10.108.
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.
BCI and related vascular procedures were identified by ICD-9-CM codes from the National Trauma Data Bank(1) 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.
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.
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.
钝性颈动脉损伤（BCI）并不常见，但潜在危害极大。这种损伤的最佳治疗方式仍未确定。我们进行这项研究是为了更好地了解接受不同干预措施的 BCI 患者的住院过程和治疗结果。
通过国际疾病分类第 9 版临床修正码（ICD-9-CM）从国家创伤数据库（1）中确定 BCI 和相关血管手术，数据收集时间为 2002 年至 2006 年。通过患者人口统计学、急诊科（ED）初始评估、住院过程和治疗结果等变量比较保守治疗和手术治疗组。进一步比较开放手术和血管内介入治疗。
从 1633126 例出院的钝性创伤患者中发现了 842 例 BCI（0.05%）。其中 762 例（90.5%）接受保守治疗，80 例（9.5%）接受手术治疗。这些治疗组在人口统计学方面没有差异。在初始评估时，保守治疗组和手术治疗组在生命体征、格拉斯哥昏迷量表、血液中是否存在药物或酒精以及创伤相关损伤严重程度评分的生存率方面没有差异。在基础缺陷（-3.1 ± 6.8 与-7.6 ± 8.3；P =.01）、头部 CT 扫描阳性的可能性（58.6%与 26.1%；P =.003）和损伤严重程度评分（29.8 ± 13.3 与 26.1 ± 14.1；P =.02）方面存在显著差异。住院过程和治疗结果相当，住院时间（13.4 ± 15.3 天与 13.7 ± 13.6 天；P =.86）、总功能独立性测量（8.8 ± 3.3 与 9.3 ± 3.1；P =.38）、原始神经损伤进展（7.5%与 4.6%；P =.61）或死亡率（28.1%与 19%；P =.08）无差异。比较开放手术和血管内介入治疗（46 例开放手术，34 例血管内介入治疗，包括 3 例联合治疗），唯一显著差异在于损伤严重程度评分（22.4 ± 12.2 与 31.4 ± 15.4；P =.01）和 ICU 和住院时间（5.0 ± 6.0 天与 10.7 ± 10.4 天；P =.01，和 10.3 ± 9.2 天与 19.3 ± 17.7 天；P =.01）。多变量回归分析证实，功能独立性测量（FIM）和死亡率均与保守或手术治疗无关。
BCI 较为罕见，预后较差。手术干预并不能提高功能恢复或生存率。本研究无法支持与开放手术相比，微创的血管内治疗能改善治疗效果。
