دورية أكاديمية
أعرض في EDS

The effect of circle of willis anatomy and scanning practices on outcomes for blunt cerebrovascular injuries.

التفاصيل البيبلوغرافية
العنوان: The effect of circle of willis anatomy and scanning practices on outcomes for blunt cerebrovascular injuries.
المؤلفون: Bar-Or D; Swedish Medical Center, Englewood, CO, USA. davidbme49@gmail.com.; Injury Outcomes Network, Colorado, , Englewood, United States. davidbme49@gmail.com., Jarvis S; Swedish Medical Center, Englewood, CO, USA.; Injury Outcomes Network, Colorado, , Englewood, United States., Lensing F; Saint Anthony Hospital, Colorado, , Lakewood, United States., Bassa D; Medical City Plano, Texas, , Plano, United States., Carrick M; Medical City Plano, Texas, , Plano, United States., Palacio Lascano C; South Texas Health System McAllen, Texas, , McAllen, United States., Busch M; Swedish Medical Center, Englewood, CO, USA., Hamilton D; Penrose Hospital, CO, , Colorado Springs, United States., Acuna D; Wesley Medical Center, Kansas, , Wichita, United States., Greenseid S; Swedish Medical Center, Englewood, CO, USA., Ojala D; Saint Anthony Hospital, Colorado, , Lakewood, United States.
المصدر: Scandinavian journal of trauma, resuscitation and emergency medicine [Scand J Trauma Resusc Emerg Med] 2024 Jun 17; Vol. 32 (1), pp. 57. Date of Electronic Publication: 2024 Jun 17.
نوع المنشور: Comparative Study; Journal Article; Multicenter Study
اللغة: English
بيانات الدورية: Publisher: BioMed Central Country of Publication: England NLM ID: 101477511 Publication Model: Electronic Cited Medium: Internet ISSN: 1757-7241 (Electronic) Linking ISSN: 17577241 NLM ISO Abbreviation: Scand J Trauma Resusc Emerg Med Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : BioMed Central
مواضيع طبية MeSH: Cerebrovascular Trauma*/diagnostic imaging , Circle of Willis*/abnormalities , Circle of Willis*/anatomy & histology , Circle of Willis*/diagnostic imaging , Wounds, Nonpenetrating*/complications, Adult ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Trauma Centers
مستخلص: Background: Limited research has explored the effect of Circle of Willis (CoW) anatomy among blunt cerebrovascular injuries (BCVI) on outcomes. It remains unclear if current BCVI screening and scanning practices are sufficient in identification of concomitant COW anomalies and how they affect outcomes.
Methods: This retrospective cohort study included adult traumatic BCVIs at 17 level I-IV trauma centers (08/01/2017-07/31/2021). The objectives were to compare screening criteria, scanning practices, and outcomes among those with and without COW anomalies.
Results: Of 561 BCVIs, 65% were male and the median age was 48 y/o. 17% (n = 93) had a CoW anomaly. Compared to those with normal CoW anatomy, those with CoW anomalies had significantly higher rates of any strokes (10% vs. 4%, p = 0.04), ICHs (38% vs. 21%, p = 0.001), and clinically significant bleed (CSB) before antithrombotic initiation (14% vs. 3%, p < 0.0001), respectively. Compared to patients with a normal CoW, those with a CoW anomaly also had ischemic strokes more often after antithrombotic interruption (13% vs. 2%, p = 0.02).Patients with CoW anomalies were screened significantly more often because of some other head/neck indication not outlined in BCVI screening criteria than patients with normal CoW anatomy (27% vs. 18%, p = 0.04), respectively. Scans identifying CoW anomalies included both the head and neck significantly more often (53% vs. 29%, p = 0.0001) than scans identifying normal CoW anatomy, respectively.
Conclusions: While previous studies suggested universal scanning for BCVI detection, this study found patients with BCVI and CoW anomalies had some other head/neck injury not identified as BCVI scanning criteria significantly more than patients with normal CoW which may suggest that BCVI screening across all patients with a head/neck injury may improve the simultaneous detection of CoW and BCVIs. When screening for BCVI, scans including both the head and neck are superior to a single region in detection of concomitant CoW anomalies. Worsened outcomes (strokes, ICH, and clinically significant bleeding before antithrombotic initiation) were observed for patients with CoW anomalies when compared to those with a normal CoW. Those with a CoW anomaly experienced strokes at a higher rate than patients with normal CoW anatomy specifically when antithrombotic therapy was interrupted. This emphasizes the need for stringent antithrombotic therapy regimens among patients with CoW anomalies and may suggest that patients CoW anomalies would benefit from more varying treatment, highlighting the need to include the CoW anatomy when scanning for BCVI.
Level of Evidence: Level III, Prognostic/Epidemiological.
(© 2024. The Author(s).)
References: J Vasc Surg. 2018 Dec;68(6):1764-1771. (PMID: 29983353)
Cureus. 2020 Aug 23;12(8):e9968. (PMID: 32983672)
Int J Crit Illn Inj Sci. 2020 Apr-Jun;10(2):81-87. (PMID: 32904506)
J Trauma Acute Care Surg. 2020 Jun;88(6):789-795. (PMID: 32195997)
J Trauma Acute Care Surg. 2014 Mar;76(3):691-5. (PMID: 24553535)
J Trauma. 2009 Jan;66(1):132-43; discussion 143-4. (PMID: 19131816)
Eur J Trauma Emerg Surg. 2021 Feb;47(1):161-170. (PMID: 31197394)
J Trauma. 2010 Feb;68(2):471-7. (PMID: 20154559)
Ann Surg. 2002 May;235(5):699-706; discussion 706-7. (PMID: 11981216)
Stroke. 2004 Jan;35(1):104-8. (PMID: 14671241)
Radiology. 2020 Nov;297(2):428-435. (PMID: 32897159)
World J Surg. 2018 Jul;42(7):2043-2053. (PMID: 29270652)
AJNR Am J Neuroradiol. 2004 Apr;25(4):558-64. (PMID: 15090341)
J Trauma Acute Care Surg. 2012 Feb;72(2):330-5; discussion 336-7, quiz 539. (PMID: 22327974)
Surgery. 2015 Sep;158(3):627-35. (PMID: 26067461)
BMC Neurosci. 2021 Jan 21;22(1):3. (PMID: 33478402)
J Int Med Res. 2017 Apr;45(2):723-732. (PMID: 28173711)
J Trauma Acute Care Surg. 2015 Mar;78(3):614-21. (PMID: 25710435)
Emerg Radiol. 2019 Aug;26(4):365-372. (PMID: 30756247)
J Neurosurg. 2017 Jul;127(1):32-35. (PMID: 27767400)
J Am Coll Surg. 2023 Mar 1;236(3):468-475. (PMID: 36440860)
Ann Surg. 1996 May;223(5):513-22; discussion 522-5. (PMID: 8651742)
J Neurosurg. 2018 Jun;128(6):1642-1647. (PMID: 28799874)
J Trauma. 1999 Nov;47(5):845-53. (PMID: 10568710)
Radiographics. 2018 Mar-Apr;38(2):542-563. (PMID: 29528828)
Can Assoc Radiol J. 2020 Aug;71(3):281-292. (PMID: 32174162)
Stroke. 2020 Jan;51(1):353-360. (PMID: 31822250)
Am Surg. 2021 Mar;87(3):390-395. (PMID: 32993322)
J Trauma. 2002 May;52(5):896-901. (PMID: 11988655)
J Trauma. 2001 Aug;51(2):279-85; discussion 285-6. (PMID: 11493785)
Arch Surg. 2004 May;139(5):540-5; discussion 545-6. (PMID: 15136355)
Trauma Surg Acute Care Open. 2017 Apr 27;2(1):e000086. (PMID: 29766090)
J Comput Assist Tomogr. 2020 Nov/Dec;44(6):941-946. (PMID: 33196601)
Scand J Trauma Resusc Emerg Med. 2018 Oct 29;26(1):90. (PMID: 30373641)
J Trauma. 2011 Jul;71(1):114-9. (PMID: 21818020)
World J Emerg Surg. 2018 Jul 4;13:30. (PMID: 29997683)
Medicine (Baltimore). 2016 Mar;95(10):e2892. (PMID: 26962785)
J Trauma. 2009 Dec;67(6):1150-3. (PMID: 20009659)
J Stroke Cerebrovasc Dis. 2020 Jun;29(6):104804. (PMID: 32305279)
Tomography. 2022 Feb 07;8(1):402-413. (PMID: 35202198)
J Trauma. 2009 Sep;67(3):551-6; discussion 555-6. (PMID: 19741399)
Ann Surg. 2013 Apr;257(4):621-32. (PMID: 23470509)
J Am Coll Surg. 2018 Nov;227(5):521-536.e1. (PMID: 30145286)
J Trauma Acute Care Surg. 2021 Feb 1;90(2):224-231. (PMID: 33502144)
J Trauma Acute Care Surg. 2013 Dec;75(6):941-6. (PMID: 24256664)
J Trauma Acute Care Surg. 2020 Nov;89(5):880-886. (PMID: 32520898)
Arch Surg. 2009 Jul;144(7):685-90. (PMID: 19620551)
Am J Emerg Med. 2021 Jan;39:121-124. (PMID: 32005409)
Trauma Surg Acute Care Open. 2020 Sep 15;5(1):e000457. (PMID: 32984546)
J Trauma Acute Care Surg. 2014 Feb;76(2):279-83; discussion 284-5. (PMID: 24458034)
Trauma Surg Acute Care Open. 2021 Apr 26;6(1):e000668. (PMID: 33981860)
فهرسة مساهمة: Keywords: Blunt cerebrovascular injury; Scanning practices; Screening criteria; Trauma
تواريخ الأحداث: Date Created: 20240617 Date Completed: 20240618 Latest Revision: 20240808
رمز التحديث: 20240809
مُعرف محوري في PubMed: PMC11181559
DOI: 10.1186/s13049-024-01225-x
PMID: 38886775
قاعدة البيانات: MEDLINE
الوصف
تدمد:1757-7241
DOI:10.1186/s13049-024-01225-x