穿透性颈动脉创伤性卒中的危险因素——来自PROOVIT注册研究的分析
Risk factors for stroke in penetrating carotid trauma-An analysis from the PROOVIT Registry.
作者信息
O'Banion Leigh Ann, Dirks Rachel C, Siada Sammy S, Dubose Joseph J, Inaba Kenji, Byerly Saskya, Rajani Ravi R, Morrison Jonathan J, Lucero Leah, Magee Gregory A
机构信息
From the Division of Vascular Surgery, Department of Surgery (L.A.OB., R.C.D., S.S.S., L.L.), University of California San Francisco-Fresno, Fresno, California; Division of Trauma and Critical Care (J.J.D., J.J.M.), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland; Division of Vascular and Endovascular Surgery and Division of Trauma and Critical Care, Department of Surgery (K.I., G.A.M.), University of Southern California, Los Angeles, California; Division of Trauma and Critical Care, Department of Surgery (S.B.), University of Miami, Jackson Memorial Hospital Ryder Trauma Center, Miami, Florida; and Division of Vascular Surgery and Endovascular Therapy, Department of Surgery (R.R.R.), Emory University School of Medicine, Atlanta, Georgia.
出版信息
J Trauma Acute Care Surg. 2022 Apr 1;92(4):717-722. doi: 10.1097/TA.0000000000003519.
BACKGROUND
Penetrating carotid injuries are associated with an up to 20% risk of stroke. This study evaluated patients in the American Association for Surgery of Trauma PROspective Observational Vascular Injury Trial, with the aim of determining factors associated with stroke and stroke or death.
METHODS
Penetrating extracranial carotid injuries in the American Association for Surgery of Trauma PROspective Observational Vascular Injury Trial registry from 2012 to 2020 were queried. Isolated external carotid injuries were excluded. Patients with documented postinjury in-hospital stroke were compared with those without. Significant predictors (p < 0.1) for stroke and stroke or death on univariate analysis were included in multivariate analyses.
RESULTS
One hundred two patients from 17 institutions were included. Mean age was 35 ± 18 years, and 80% were male. Average Glasgow Coma Scale (GCS) score on presentation was 9 ± 5, with an Injury Severity Score [ISS] of 22 ± 13. Operative management occurred in 51% of patients who were significantly more hypotensive (systolic blood pressure: 109 vs. 131 mm Hg; p = 0.015) with a lower initial pH (7.17 vs. 7.31; p = 0.001) and presented with hard signs of vascular injury (74% vs. 26%; p < 0.001). Overall stroke rate was 17% (23% operative vs. 10% nonoperative, p = 0.076). Rate of stroke or death was 27% (64% operative and 36% nonoperative). On multivariate analysis, lower GCS (p = 0.05) and completion angiography (p = 0.04) were associated with stroke. Likewise lower GCS (p = 0.015) and ISS (p = 0.04) were associated with stroke or death.
CONCLUSION
Penetrating carotid trauma undergoing operative management had a stroke rate of 23%. Low GCS on arrival and need for completion angiography are independently associated with postinjury in-hospital stroke, whereas low GCS on arrival and ISS were associated with stroke or death. The ideal treatment strategy remains elusive, thus a dedicated multicenter study may help to achieve higher fidelity data on this rare but devastating injury.
LEVEL OF EVIDENCE
Prognostic and Epidemiological, Level III.
背景
穿透性颈动脉损伤导致中风的风险高达20%。本研究评估了美国创伤外科学会前瞻性观察性血管损伤试验中的患者，旨在确定与中风以及中风或死亡相关的因素。
方法
查询了美国创伤外科学会前瞻性观察性血管损伤试验登记处2012年至2020年期间的穿透性颅外颈动脉损伤情况。排除单纯的颈外动脉损伤。将有记录的伤后院内中风患者与无中风患者进行比较。单因素分析中中风以及中风或死亡的显著预测因素（p<0.1）纳入多因素分析。
结果
纳入了来自17家机构的102例患者。平均年龄为35±18岁，80%为男性。入院时格拉斯哥昏迷量表（GCS）平均评分为9±5，损伤严重程度评分（ISS）为22±13。51%的患者接受了手术治疗，这些患者的低血压情况更严重（收缩压：109 vs. 131 mmHg；p = 0.015），初始pH值更低（7.17 vs. 7.31；p = 0.001），且出现血管损伤的硬体征（74% vs. 26%；p<0.001）。总体中风发生率为17%（手术治疗患者为23%，非手术治疗患者为10%，p = 0.076）。中风或死亡发生率为27%（手术治疗患者为64%，非手术治疗患者为36%）。多因素分析显示，较低的GCS（p = 0.05）和完成血管造影（p = 0.04）与中风相关。同样，较低的GCS（p = 0.015）和ISS（p = 0.04）与中风或死亡相关。
结论
接受手术治疗的穿透性颈动脉创伤患者中风发生率为23%。入院时GCS较低以及需要完成血管造影与伤后院内中风独立相关，而入院时GCS较低和ISS与中风或死亡相关。理想的治疗策略仍不明确，因此一项专门的多中心研究可能有助于获得关于这种罕见但具有毁灭性损伤的更高质量数据。
证据水平
预后和流行病学，三级。
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