Blunt Vascular Injuries of the Head and Neck
| Autor: | R. Lawrence Reed, Soumitra R. Eachempati, Steven N. Vaslef, Mark W. Sebastian |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Wounds Nonpenetrating Medical Records law.invention Neck Injuries Injury Severity Score Blunt Randomized controlled trial law medicine.artery Carotid canal Craniocerebral Trauma Humans Medicine Glasgow Coma Scale Cerebrovascular Trauma Emergency Treatment Aged Retrospective Studies Heparin business.industry Vascular disease Trauma center Anticoagulants Middle Aged medicine.disease Surgery medicine.anatomical_structure Anesthesia Blood Vessels Female Internal carotid artery business Complication |
| Zdroj: | The Journal of Trauma: Injury, Infection, and Critical Care. 45:997-1004 |
| ISSN: | 1079-6061 |
| DOI: | 10.1097/00005373-199812000-00004 |
| Popis: | Background: Blunt vascular injuries to the head and neck (BHVI) represent some of the most devastating and morbid injuries seen by a trauma surgeon. This series reviewed the experience of a single institution to determine if diagnostic and therapeutic guidelines can be established for these uncommon injuries. In particular, the utility of anticoagulation in the treatment of these injuries is examined. Methods: The institutional trauma registry of a single state-designated Level I trauma center was examined for patients with BHVI. Patients were identified and their charts reviewed individually with regard to multiple data points including the type of injury, its presentation, the treatment of the injury, and the functional outcome of the patient. Results: Twenty-nine BHVI in 23 patients were reviewed from 1989 to 1997. No mortalities were noted. Among the injuries noted were 14 internal carotid artery dissections and 8 carotid artery tears. Thirteen patients had accompanying closed head injuries. Ten patients were diagnosed after an abnormal neurologic examination, and eight others were diagnosed after having carotid canal fractures. Heparin was started within 48 hours of injury in 4 patients (17%) and was used in a total of 12 patients (52%). No patient worsened neurologically after diagnosis independent of the use of heparin. Thirteen patients (57%) had no or minimal deficits upon discharge. Conclusion: BHVI represent a serious cause of morbidity in the patient with multiple injuries. Patients with closed head injuries and carotid canal fractures appear most at risk. A multicenter, randomized trial involving antiplatelet therapy, full systemic anticoagulation, or observation with a long-term functional assessment is indicated to determine the optimal management of these injuries. |
| Databáze: | OpenAIRE |
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