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Different strokes: differences in the characteristics and outcomes of BCVI and non-BCVI strokes in trauma patients
  1. Michelle K McNutt1,
  2. Cedar Slovacek2,
  3. David Rosenbaum3,
  4. Hari Kishan Reddy Indupuru2,
  5. Xu Zhang4,
  6. Bryan A Cotton1,
  7. John Harvin1,
  8. Charles E Wade1,
  9. Sean I Savitz5,
  10. Lillian S Kao1
  1. 1Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
  2. 2University of Texas McGovern Medical School, Houston, Texas, USA
  3. 3Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA
  4. 4Center for Clinical and Translational Sciences, University of Texas McGovern Medical School, Houston, Texas, USA
  5. 5UTHealth Institute for Stroke and Cerebrovascular Disease, University of Texas McGovern Medical School, Houston, Texas, USA
  1. Correspondence to Dr Michelle K McNutt, Surgery, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; Michelle.K.McNutt{at}uth.tmc.edu

Abstract

Background Although strokes are rare in trauma patients, they are associated with worse functional and cognitive outcomes and decreased mobility. Blunt cerebrovascular injury (BCVI)–related strokes and mortality have decreased, likely due to refined screening and treatment algorithms in trauma literature; however, there is a paucity of research addressing non-BCVI strokes in trauma. The purpose of this study is to evaluate the incidence, etiology, and risk factors of stroke in our trauma population in order to identify preventive strategies.

Methods This study was a retrospective review of all adult trauma patients admitted to a level 1 trauma hospital who suffered a stroke during trauma admission from 2010 to 2017. Data were collected from the prospectively maintained trauma and stroke databases. Stroke etiology was determined by a vascular neurologist.

Results Of the 43 674 adult trauma patients admitted during the study period, 99 (0.2%) were diagnosed with a stroke during the index admission. Twenty-one (21%) strokes were due to BCVI. Seventy-eight (79%) strokes were due to non-BCVI etiologies. Patients with non-BCVI strokes were older, less severely injured, and had more medical comorbidities compared with patients with a BCVI stroke. While patients with a BCVI stroke were more likely to suffer multiple traumatic injuries from MVC (76% vs 28%, p<0.001), non-BCVI strokes had more isolated extremity injuries from fall mechanism (55% vs 10%, p<0.001). Over the study period, the age and incidence of stroke and BCVI (p<0.001) increased. However, the rate of BCVI strokes decreased while the rate of non-BCVI strokes increased.

Discussion The incidence of stroke has increased despite aggressive screening and treatment of BCVI. This increase is primarily due to non-BCVI strokes which are associated with advanced age and medical comorbidities after low mechanism traumatic injury. Medical optimization of comorbid conditions during trauma hospitalization will become increasingly important for stroke prevention as the population ages.

Level of evidence: Level III

  • stroke
  • blunt trauma
  • cerebrovascular injury
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Footnotes

  • Contributors MKM, SIS, CEW, and LSK made substantial contributions to the conception and design of study. MKM, CS, DR, HKRI, XZ, BAC, and LSK made substantial contributions to the acquisition, analysis, and interpretation of the data. MKM wrote the manuscript. BAC, JH, CEW, SIS, and LSK performed critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The protocol was approved by the Institutional Review Board (IRB) at the University of Texas Health Science Center (HSC-GEN-13_0325). As this was a retrospective study, the consent by the subjects was not required by the IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information. Data will be made available under a Data Use Agreement through the University of Texas McGovern Medical School.

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