Penetrating Injury to the Carotid Artery: Characterizing Presentation and Outcomes from the National Trauma Data Bank.

BACKGROUND: Penetrating injury to the neck can be devastating due to the multiple vital structures in close proximity. In the event of injury to the carotid artery, there is a significantly increased likelihood of morbidity or mortality. The purpose of this study was to assess presenting characteristics associated with penetrating injury to the carotid artery, and directly compare approaches to surgical management. METHODS: Data from the National Trauma Data Bank from 2002-2016 was accessed to evaluate adult patients sustaining penetrating injury to the common or internal carotid artery. Management (operative vs. non-operative) and surgical approach (open vs. endovascular) were evaluated based on presentation characteristics; and outcomes were compared after propensity-score matching. RESULTS: 3,391 patients fitting inclusion criteria and surviving past the the emergency department were included in analyses (non-operative: 1,976 [58.3%], operative: 1,415 [41.7%] patients). The operative group was further classified by intervention: open = 1,192, endovascular: 154. On presentation, the non-operative group demonstrated significantly higher prevalence of: coma (Glasgow Coma Scale [GCS] /=25: non-operative = 42.3% vs. operative = 33.3%, P /= 3: non-operative = 44.9% vs. operative = 22.0%, P < 0.001). After propensity-score matching, the non-operative group demonstrated higher mortality (non-operative = 28.9% vs. operative = 18.5%, P < 0.001), and lower rates of stroke (non-operative = 6.6% vs. operative -= 10.5%, P < 0.001). There were no differences in outcomes relating to surgical approach. CONCLUSIONS: These results indicate that non-operative patients often present with a more severe overall injury burden, particularly injury to the head, and not surprisingly, have higher rates of mortality. The lack of significant differences in outcomes relating to surgical approach indicates open vs. endovascular invention should be individualized to the patient-e.g., based on presenting characteristics and the location of the injury.