Article Figures & Tables
Tables
- Table 1
Characteristics of patients with blunt cerebrovascular injuries stratified by Biffl grade
Characteristic Biffl grade; no. (%) of patients* 1–2
n = 973
n = 264
n = 63Age, mean ± SD, yr 44.4 ± 20.2 44.7 ± 17.4 55.2 ± 18.5 Injury Severity Score, mean ± SD 28.4 ± 14.5 30.3 ± 13.0 26.9 ± 18.0 Gender Male 63 (65) 17 (65) 47 (75) Female 34 (35) 9 (35) 16 (25) Mechanism of injury Motor vehicle collision 36 (37) 7 (27) 17 (27) Motorcycle collision 6 (6) 7 (27) 6 (10) Pedestrian accident 16 (16) 2 (8) 6 (10) Fall from height 25 (26) 6 (23) 24 (38) Other† 14 (14) 4 (15) 10 (16) Criterion Biffl grade; no. (%) of patients 1–2 3 4 Signs or symptoms of BCVI Potential arterial hemorrhage from neck, nose or mouth 3 (3) 3 (3) 0 (0) Expanding cervical hematoma 0 (0) 1 (3) 1 (3) Focal neurologic deficit (TIA, hemiparesis, vertebrobasilar symptoms, Horner syndrome) 13 (3) 6 (3) 13 (3) Neurologic examination findings incongruous with head CT findings 1 (3) 0 (0) 0 (0) Ischemic stroke on CT or MRI 6 (3) 3 (3) 9 (3) Risk factors for BCVI in setting of high-energy–transfer mechanism Displaced midface fracture (Le Fort II or III) 2 (3) 1 (3) 0 (0) Mandible fracture 6 (3) 4 (3) 1 (3) Complex skull fracture, basilar skull fracture or occipital condyle fracture 20 (3) 5 (3) 8 (3) Severe traumatic brain injury with GCS score < 6 25 (3) 2 (3) 12 (3) Cervical spine fracture, subluxation or ligamentous injury at any level 44 (3) 6 (3) 44 (3) Clothesline-type injury or seat belt abrasion with significant swelling, pain or altered level of consciousness 3 (3) 2 (3) 0 (0) Scalp degloving 3 (3) 0 (0) 1 (3) Thoracic vascular injury 22 (3) 8 (3) 7 (3) Upper rib fracture 24 (3) 5 (3) 9 (3) BCVI = blunt cerebrovascular injury; CT = computed tomography; GCS = Glasgow Coma Scale; MRI = magnetic resonance imaging; TIA = transient ischemic attack.
Timing of CTA Biffl grade; no. (%) of patients 1–2
n = 923
n = 264
n = 53Within 7 d 33 (36) 13 (50) 15 (28) Within 30 d 19 (21) 4 (15) 5 (9) Within 90 d 10 (11) 3 (12) 10 (19) > 90 d 8 (9) 0 (0) 6 (11) Received follow-up scan during hospital stay† 49/84 (58) 14/19 (74) 18/46 (39) No CTA 22 (24) 6 (23) 17 (32) - Table 4
Timing of treatment initiation and medical treatment modality stratified by Biffl grade
Timing and modality Biffl grade; no. (%) of patients 1–2 3 4 Timing of treatment initiation Within 48 h of diagnosis 64 (66) 18 (69) 46 (73) Delayed (> 48 h) With contraindications 13 (13) 6 (23) 5 (8) Without contraindications 8 (8) 0 (0) 2 (3) Untreated Owing to contraindications* 5 (5) 1 (4) 0 (0) Despite no contraindications 2 (2) 1 (4) 1 (2) Owing to death/palliative care 5 (5) 0 (0) 9 (14) Medical treatment modality/regimen ASA Low-dose (81 mg) 74 (76) 18 (69) 40 (63) Loading dose (325 mg), then low-dose 1 (1) 3 (12) 4 (6) Alternative dosage (e.g., 160 mg) 2 (2) 1 (4) 1 (2) Warfarin with heparin bridge 1 (1) 1 (4) 0 (0) Warfarin with heparin bridge + ASA 0 (0) 0 (0) 2 (3) Low-molecular-weight heparin (therapeutic) 2 (2) 0 (0) 0 (0) Clopidogrel 1 (1) 0 (0) 3 (5) Clopidogrel + ASA 4 (4) 1 (4) 3 (5) Untreated 12 (12) 2 (8) 10 (16) ASA = acetylsalicylic acid.
↵* Includes active hemorrhage requiring intervention or resuscitation, and high risk of bleeding into a critical site, including intracranial, intraspinal or retroperitoneal.
- Table 5
Timing and setting of stroke within 3 months of initial diagnosis stratified by Biffl grade
Timing/setting of stroke Biffl grade; no. (%) of patients 1–2
n = 73
n = 84
n = 14Present at time of arrival 6 (86) 3 (38) 9 (64) While receiving treatment for BCVI 0 (0) 3 (38) 1 (7) While untreated for BCVI because of contraindications 1 (14) 2 (2) 4 (29) BCVI = blunt cerebrovascular injury.