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Time to stroke: A Western Trauma Association multicenter study of blunt cerebrovascular injuries
CONCLUSIONS The majority of patients suffer BCVI-related stroke in the first 72 hours after injury. Time to stroke can help inform clinicians about initiation of treatment in the multiply injured patient. LEVEL OF EVIDENCE Prognostic/Epidemiologic, level III.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - October 26, 2018 Category: Orthopaedics Tags: 2018 WTA PODIUM PAPER Source Type: research

Not all in your head (and neck): Stroke after blunt cerebrovascular injury is associated with systemic hypercoagulability
CONCLUSION Patients who suffer BCVI-related stroke are hypercoagulable compared with those with BCVI who remain asymptomatic. Increased angle or MA should be considered when assessing the risk of thrombosis and determining the optimal time to initiate antithrombotic therapy in patients with BCVI. LEVEL OF EVIDENCE Prognostic, Level III.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Factors associated with stroke formation in blunt cerebrovascular injury: An EAST multicenter study
BACKGROUND Stroke risk factors after blunt cerebrovascular injury (BCVI) are ill-defined. We hypothesized that factors associated with stroke for BCVI would include medical therapy (i.e., Aspirin), radiographic features, and protocolization of care. METHODS An Eastern Association for the Surgery of Trauma–sponsored, 16-center, prospective, observational trial was undertaken. Stroke risk factors were analyzed individually for vertebral artery (VA) and internal carotid artery (ICA) BCVI. Blunt cerebrovascular injuries were graded on the standard 1 to 5 scale. Data were from the initial hospitalization only. R...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - February 1, 2022 Category: Orthopaedics Tags: 2021 EAST PODIUM PAPERS Source Type: research

A safe and effective management strategy for blunt cerebrovascular injury: Avoiding unnecessary anticoagulation and eliminating stroke
CONCLUSION: This management scheme using 64-channel CTA for screening coupled with DSA for definitive diagnosis was proven to be safe and effective in identifying clinically significant BCVIs and maintaining a low stroke rate. Definitive diagnosis by DSA led to avoidance of potentially harmful anticoagulation in 45% of CTA-positive patients (false-positive results). No strokes resulted from injuries missed by CTA. LEVEL OF EVIDENCE: Diagnostic study, level III.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - May 21, 2016 Category: Orthopaedics Tags: AAST 2015 Plenary Papers Source Type: research

Imaging analysis of ischemic strokes due to blunt cerebrovascular injury
CONCLUSION With universal screening, CTA evidence of BCVI is common among blunt trauma patients. Although acute stroke is also relatively common in this population, two thirds of strokes are already evident on admission. One third of BCVI-related strokes occur after admission and often relatively early, necessitating rapid commencement of preventative treatment. Further studies are required to demonstrate the value of antithrombotic administration in preventing stroke in BCVI patients. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level IV.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - June 1, 2022 Category: Orthopaedics Tags: 2020 AAST QUICK SHOT Source Type: research

Blunt cerebrovascular injuries: Outcomes from the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) multicenter registry
CONCLUSION Stroke and death remain significant risks for all BCVI grades regardless of the vessel injured. Antithrombotics represent the only management strategy that is consistently associated with a lower incidence of stroke and death in all BCVI categories. In the multi-injured BCVI patient with a high risk of bleeding on anticoagulation, antiplatelet agents are an efficacious alternative. Given the 40% mortality rate in patients who survived their initial trauma and developed a BCVI-related stroke, nontreatment may no longer be a viable option. LEVEL OF EVIDENCE Epidemiological III; Therapeutic IV.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - June 1, 2021 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

Early antithrombotic therapy is safe and effective in patients with blunt cerebrovascular injury and solid organ injury or traumatic brain injury
CONCLUSION: Initiation of early AT for patients with BCVI and concomitant TBI or SOI does not increase risk of worsening TBI or SOI above baseline. Close monitoring is required, but our results suggest that appropriate antiplatelet or heparin therapy should not be withheld in patients with BCVI and concomitant TBI or SOI. In fact, prompt treatment with either antiplatelet or heparin therapy remains the mainstay for prevention of stroke-related morbidity and mortality in these patients. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - June 22, 2016 Category: Orthopaedics Tags: Original Articles Source Type: research

Intraoperative hypotensive resuscitation for patients undergoing laparotomy or thoracotomy for trauma: Early termination of a randomized prospective clinical trial
Conclusion: This study was unable to demonstrate that hypotensive resuscitation at a target MAP of 50 mm Hg could significantly improve 30-day mortality. Further study is necessary to fully realize the benefits of hypotensive resuscitation. LEVEL OF EVIDENCE: Therapeutic study, level II.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - May 21, 2016 Category: Orthopaedics Tags: AAST 2015 Plenary Papers Source Type: research

New ischemic lesions on brain magnetic resonance imaging in patients with blunt traumatic cerebrovascular injury
BACKGROUND Patients with blunt cerebrovascular injuries are at risk of thromboembolic stroke. Although primary prevention with antithrombotic therapy is widely used in this setting, its effectiveness is not well defined and requires further investigation. The aim of this study was to evaluate the utility of magnetic resonance imaging (MRI)–detected ischemic brain lesions as a possible future outcome for randomized clinical trials in this patient population. METHODS This prospective observational study included 20 adult blunt trauma patients admitted to a level I trauma center with a screening neck CTA showing extrac...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - May 29, 2020 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

Impact of marijuana on venous thromboembolic events: Cannabinoids cause clots in trauma patients
CONCLUSION THC exposure increases the risk of TEC in patients with trauma. Early identification and treatment for TEC is required to improve outcomes in this high-risk subset of trauma patients. LEVEL OF EVIDENCE Prognostic study, level III.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - June 23, 2020 Category: Orthopaedics Tags: 2020 EAST PODIUM PAPER Source Type: research

Antithrombotic choice in blunt cerebrovascular injuries: Experience at a tertiary trauma center, systematic review, and meta-analysis
BACKGROUND Blunt cerebrovascular injuries (BCVIs) may occur following trauma and lead to ischemic stroke if untreated. Antithrombotic therapy decreases this risk; however, the optimal agent has yet to be determined in this population. The aim of this study was to compare the risk-benefit profile of antiplatelet (AP) versus anticoagulant (AC) therapy in rates of ischemic stroke and hemorrhagic complications in BCVI patients. METHODS We performed a retrospective review of BCVI patients at our tertiary care Trauma hospital from 2010 to 2015, and a systematic review and meta-analysis of the literature. The OVID Medl...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - June 29, 2021 Category: Orthopaedics Tags: REVIEW ARTICLE Source Type: research

An estrogen (17α-ethinyl estradiol-3-sulfate) reduces mortality in a swine model of multiple injuries and hemorrhagic shock
BACKGROUND Although 17α-ethinyl estradiol-3-sulfate (EES) reduces mortality in animal models of controlled hemorrhage, its role in a clinically relevant injury model is unknown. We assessed the impact of EES in a swine model of multiple injuries and hemorrhage. METHODS The study was performed under Good Laboratory Practice, with 30 male uncastrated swine (25–50 kg) subjected to tibial fracture, pulmonary contusion, and 30% controlled hemorrhage for an hour. Animals were randomized to one of five EES doses: 0 (control), 0.3, 1, 3, and 5 mg/kg, administered postinjury. Subjects received no resuscitation and wer...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - December 28, 2021 Category: Orthopaedics Tags: ORIGINAL RESEARCH: 2021 AAST POSTER Source Type: research

Embedding a trauma hospitalist in the trauma service reduces mortality and 30-day trauma-related readmissions
CONCLUSION: Our study provides evidence that embedding a hospitalist on the trauma service reduces mortality and trauma-related readmissions. A reason for these improved outcomes may be related to THOSP “vigilance.” LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - June 22, 2016 Category: Orthopaedics Tags: Original Articles Source Type: research

Contemporary management of civilian penetrating cervicothoracic arterial injuries
CONCLUSIONS: Experience with penetrating arterial cervicothoracic injuries at a high-volume urban trauma center remained remarkably similar with respect to both anatomic distribution of injury and treatment. Conventional operative exposure and repair remain the cornerstone of treatment for most civilian cervicothoracic arterial injuries. LEVEL OF EVIDENCE: Therapeutic study, level V.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - July 29, 2016 Category: Orthopaedics Tags: Original Articles Source Type: research

Unfractionated heparin after TBI reduces in vivo cerebrovascular inflammation, brain edema and accelerates cognitive recovery
BACKGROUND: Severe traumatic brain injury (TBI) may increase the risk of venous thromboembolic complications; however, early prevention with heparinoids is often withheld for its anticoagulant effect. New evidence suggests low molecular weight heparin reduces cerebral edema and improves neurological recovery after stroke and TBI, through blunting of cerebral leukocyte (LEU) recruitment. It remains unknown if unfractionated heparin (UFH) similarly affects brain inflammation and neurological recovery post-TBI. We hypothesized that UFH after TBI reduces cerebral edema by reducing LEU-mediated inflammation and improves neurolo...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 24, 2016 Category: Orthopaedics Tags: WTA 2016 Plenary Papers Source Type: research

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