TIME TO STROKE: A WESTERN TRAUMA ASSOCIATION MULTI-CENTER STUDY OF BLUNT CEREBROVASCULAR INJURIES

Background Screening for blunt cerebrovascular injuries (BCVI) in asymptomatic high-risk patients has become routine. To date, the length of this asymptomatic period has not been defined. Determining the time to stroke could impact therapy including earlier initiation of antithrombotics in multiply injured patients. The purpose of this study is to determine the time to stroke in patients with a BCVI-related stroke. We hypothesized the majority of patients suffer stroke between 24-72 hours after injury. Methods Patients with a BCVI-related stroke from January 2007-January 2017 from 37 trauma centers were reviewed. Results During the 10-year study, 492 patients suffered a BCVI-related stroke; the majority were men (61%) with a median age of 39 and ISS of 29. Stroke was present at admission in 182 (37%) patients and occurred during an IR procedure in 6 patients. In the remaining 304 patients, stroke was identified a median of 48 hours after admission; 53 hours in the 144 patients identified by neurologic symptoms and 42 hours in the 160 patients without a neurologic exam and an incidental stroke identified on imaging. Of those patients with neurologic symptoms, 88 (61%) stroked within 72 hours while 56 stroked after 72 hours; there was a sequential decline in stroke occurrence over the first week. Of the 304 patients who suffered stroke after admission, 64 (22%) patients were being treated with antithrombotics when the stroke occurred. Conclusions The majority of patients suffer BCVI-related stroke in the first 72 hours after injury. Time to stroke can help inform clinicians about initiation of treatment in the multiply injured patient. Level of Evidence Level III, case series for therapeutic/prognostic management The authors have no conflicts of interest related to this study and no outside funding sources. Address correspondence to: Clay Cothren Burlew, MD FACS, Professor of Surgery, Director, Surgical Intensive Care Unit, Program Director, SCC and TACS Fellowships, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, MC 0206, Denver, CO 80204, E-Mail: clay.cothren@dhha.org © 2018 Lippincott Williams & Wilkins, Inc.

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