Blunt cerebrovascular injury in the geriatric population
| Autor: | Kinsey A. Barhorst, Laura B. Ngwenya, George Yang, James Castiglione, Sanjit Shah, Charles J. Prestigiacomo, Roman Jandarov, Diana T. Le, Shaun Keegan, Sarah Schuman Harlan |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Population ageing Computed Tomography Angiography Vertebral artery Neurological morbidity Wounds Nonpenetrating 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Blunt Geriatric population Internal medicine medicine.artery medicine Humans Cerebrovascular Trauma Vertebral Artery Aged Retrospective Studies Geriatrics medicine.diagnostic_test business.industry Trauma center General Medicine Angiography Surgery Neurology (clinical) Carotid Artery Injuries business 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgical Focus. 49:E10 |
| ISSN: | 1092-0684 |
| DOI: | 10.3171/2020.7.focus20499 |
| Popis: | OBJECTIVEBlunt cerebrovascular injury (BCVI) is associated with high rates of neurological morbidity and mortality. The detection and management of BCVI has improved with advances in imaging and sensitive screening protocols. Few studies have explored how these injuries specifically affect the geriatric population. The purpose of this retrospective analysis was to investigate the presentation and prognosis of BCVI in the elderly population and to assess its clinical implications in the management of these patients.METHODSAll patients presenting to the University of Cincinnati (UC) level I trauma center between February 2017 and December 2019 were screened for BCVI and entered into the prospectively maintained UC Neurotrauma Registry. Patients with BCVI confirmed by CT angiography underwent retrospective chart reviews to collect information regarding demographics, positive screening criteria, cause of injury, antithrombotic agent, injury location, Denver Grading Scale, hospital and ICU length of stay, and discharge disposition. Patients were divided into geriatric (age ≥ 65 years) and adult (age < 65 years) subgroups. Continuous variables were analyzed using the Student t-test and categorical variables with the Pearson chi-square test.RESULTSOf 124 patients with BCVI, stratification by age yielded 23 geriatric and 101 adult patients. Injury in the geriatric group was associated with significantly higher mortality (p = 0.0194). The most common cause of injury in the elderly was falls (74%, 17/23; p < 0.0001), whereas motor vehicle accidents were most common in the adult group (38%, 38/100; p = 0.0642). With respect to the location of injury, carotid (p = 0.1171) and vertebral artery (p = 0.6981) injuries did not differ significantly for the geriatric group. The adult population presented more often with Denver grade I injuries (p < 0.0001), whereas the geriatric population presented with grade IV injuries (p = 0.0247). Elderly patients were more likely to be discharged to skilled nursing facilities (p = 0.0403) and adults to home or self-care (p = 0.0148).CONCLUSIONSThis study is the first to characterize BCVI to all cervical and intracranial vessels in the geriatric population. Older age at presentation is significantly associated with greater severity, morbidity, and mortality from injury, with no preference for the particular artery injured. These findings carry important clinical implications for adapting practice in an aging population. |
| Databáze: | OpenAIRE |
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