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Blunt Carotid Injury and Motor Vehicle Collision: Demographics, Associated Injuries, and Outcomes
Erica H. Salinas, MD1, Viktor Y. Dombrovskiy, MD, MPH, PhD2, Parker J. Hu, MD1, Todd R. Vogel, MD, MPH1.
1University of Missouri Hospital & Clinics, Columbia, MO, USA, 2Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Objective: Blunt carotid injury (BCI) is a rare injury associated with motor vehicle collision (MVC). There are few population based analyses evaluating carotid artery dissection associated with blunt trauma and their associated injuries. The objective of this study was to describe the reported frequency of BCI, delineate associated injuries, evaluate the interventions performed, and the assess outcomes.
Methods: The NIS 2003-2010 data was queried to identify patients after MVC who also had documented carotid dissection diagnosed during their hospitalizations utilizing ICD-9 codes. Demographics, associated injuries, interventions performed, length of stay, and overall cost were evaluated.
Results: 1,686,867 patients were estimated having sustained MVC; 1,168 BCI were estimated. No patients with carotid dissection underwent an open repair, 4.24% had a carotid stent, and 95.76% of patients had no operative intervention. BCT age groups: 18-24 (27.8%), 47-60 (22.3%), 35-46 (20.6%), 25-34 (19.1%), >61 (10.2%). Associated injuries included long bone fractures (28.5%), cranial injuries (25.6%), thoracic injuries (23.6%), cervical fractures (21.8%), facial fractures (19.9%), skull fractures (18.8%), pelvic fractures (18.5%), hepatic (13.3%), and splenic (9.2%). Complications following BCI included respiratory (44.2%), stroke (28.5%), bleeding (16.1%), and urinary tract infections (8.9%). Overall mortality following BCI was 14.1% without significant difference between those with and without intervention (18.5% vs. 13.9%; P=0.36). Stroke was independently associated with a 2.1 times greater risk of mortality. Mean length of stay for patients with BCI undergoing stenting compared to no intervention were similar (13.1 days vs. 15.9 days) but had a greater mean cost ($83,030 vs. $63,200).
Conclusion: Blunt carotid dissection is a rare injury associated with motor vehicle traumas, most frequently reported in younger patients. Frequently associated injuries were long bone fractures, thoracic injuries, and pelvic fractures which may be associated with the force of the injury rather than anatomic location. The majority of patients were treated without intervention, but when carotid stenting was utilized, it did not impact mortality and tended to increase cost.
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