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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

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

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

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

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

Universal screening for blunt cerebrovascular injury
CONCLUSION Blunt cerebrovascular injury is even more common than previously thought. The diagnostic performance of selective clinical screening criteria is poor. Consideration should be given to the implementation of universal screening for BCVI using neck CTA in all blunt trauma patients. LEVEL OF EVIDENCE Diagnostic, level III.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - January 29, 2021 Category: Orthopaedics Tags: AAST 2020 PODIUM PAPERS 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

Diagnostic accuracy of different clinical screening criteria for blunt cerebrovascular injuries compared with liberal state of the art computed tomography angiography in major trauma
BACKGROUND Blunt cerebrovascular injuries (BCVI) can significantly impact morbidity and mortality if undetected and, therefore, untreated. Two diagnostic concepts are standard practice in major trauma management: Application of clinical screening criteria (CSC) does or does not recommend consecutive computed tomography angiography (CTA) of head and neck. In contrast, liberal CTA usage integrates into diagnostic protocols for suspected major trauma. First, this study's objective is to assess diagnostic accuracy of different CSC for BCVI in a population of patients diagnosed with BCVI after the use of liberal CTA. Second, ...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - May 29, 2020 Category: Orthopaedics Tags: ORIGINAL ARTICLES 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

Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma
BACKGROUND Blunt cerebrovascular injuries (BCVIs) are associated with significant morbidity and mortality. This guideline evaluates several aspects of BCVI diagnosis and management including the role of screening protocols, criteria for screening cervical spine injuries, and the use of antithrombotic therapy (ATT) and endovascular stents. METHODS Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a taskforce of the Practice Management Guidelines Committee of the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of currently avail...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - May 29, 2020 Category: Orthopaedics Tags: GUIDELINES Source Type: research

Disproportionally low funding for trauma research by the National Institutes of Health: A call for a National Institute of Trauma
CONCLUSION Given the extreme burden of trauma-related disability and years of life lost, this review of extramural NIH funding definitively demonstrates that trauma is severely underfunded. The lack of a dedicated home for trauma research at NIH leads to a diffusion of grants across many institutes and makes it impossible to direct a focused and effective national research endeavor to improve outcomes. These data demonstrate the need for a National Institute of Trauma at the NIH to help set an agenda to reach the national goal of Zero Preventable Deaths.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - December 21, 2019 Category: Orthopaedics Tags: AAST 2019 PODIUM PAPERS 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

Big problems in little patients: Nationwide blunt cerebrovascular injury outcomes in the pediatric population
BACKGROUND Blunt cerebrovascular injuries (BCVI) are uncommon but potentially devastating. The epidemiology, outcomes, and screening criteria are well described in adults, but data in pediatric patients are extremely limited. The purpose of this study was to characterize pediatric BCVI in a large nationwide sample. We hypothesized that outcomes of BCVI in the pediatric blunt trauma population will vary by age. METHODS We conducted a retrospective cohort study of the Kids' Inpatient Database for pediatric BCVI from 2000 to 2012. Epidemiology, associated injuries, outcomes (including stroke and mortality), and the utili...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Fall downs should not fall out: Blunt cerebrovascular injury in geriatric patients after low-energy trauma is common
BACKGROUND There are limited data examining the impact of screening for blunt cerebrovascular injury (BCVI) in the geriatric population sustaining falls. We hypothesize that BCVI screening in this cohort would rarely identify injuries that would change management. METHODS A retrospective study (2012–2016) identified patients 65 years or older with Abbreviated Injury Scores for the head and neck region or face region of 1 or greater after falls of 5 ft or less. Patients who met the expanded Denver criteria for BCVI screening were included for analysis. Outcomes were change in management (defined as the initiation of ...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - May 23, 2019 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

Emergency response teams in and outside of medicine—structurally crafted to be worlds apart
Medical emergency response teams (MERTs) are widespread throughout inpatient hospital care facilities. Besides the rise of the ubiquitous rapid response team, current MERTs span trauma, stroke, myocardial infarction, and sepsis in many hospitals. Given the multiplicity of teams with widely varying membership, leadership, and functionality, the structure of MERTs is appropriate to review to determine opportunities for improvement. Since nonmedical ERTs predate MERT genesis and are similar across multiple disciplines, nonmedical ERTs provide a standard against which to compare and review MERT design and function. Nonmedical...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - December 25, 2018 Category: Orthopaedics Tags: REVIEW ARTICLE Source Type: research

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