Abstract T P166: Cerebral Infarction Occurrence in Settings of Acute Traumatic Injury. Analysis of a Prospective Multicenter Trial

Abstract

Background: Acute ischemic stroke can be seen in the settings of acute traumatic injury. However, the rates of and factors associated with cerebral infarction occurrence in trauma setting are not well understood. Methods: We analyzed data from multicenter, randomized, blinded clinical trial conducted at 114 emergency medical services agencies in North America within the Resuscitation Outcomes Consortium. Initial resuscitation fluid, 250 mL of either 7.5% saline per 6% dextran 70 (hypertonic saline/dextran, HSD), 7.5% saline (hypertonic saline, HS), or 0.9% saline (normal saline, NS) administered by out-of-hospital providers. Injured patients, age ≥ 15 years with hypovolemic shock or those with blunt trauma and a prehospital Glasgow Coma Scale score of ≤8 were included. Cerebral infarction during hospitalization was one of the data ascertained at three time points: within 24 hours, within 7 days, and within 28 days. Results: Of the 1282 patients recruited, 34 developed cerebral infarction (3 <24 hrs, 25 <7 days, and 6 < 28 days). The proportion of patients with injury severity score> 26 was higher among patients with cerebral infarction (79.4% versus 45.0%, p=<.0001). The mean admission systolic blood pressure (±SD) was similar between those who did or did not develop cerebral infarction (134.1±27.6 versus 139.2±33.3, p=0.2). Patients who developed cerebral infarction were more likely to have mass lesions on initial CT scan (53% versus 15.7%, p<0.0001). A higher proportion of patients required craniotomy within 24 hrs among those who developed cerebral infarction (55.8% versus 10.8%, p=<0.0001). The 28 day survival was significantly lower among patients who developed cerebral infarction (44.1% versus 76.3%, p<0.0001). Among patients who developed cerebral infarction had a significantly higher proportion of Glasgow Outcome Scale of ≤4 (87.8% versus 56.8%, p<0.0004) at 6 months. The proportion of patients with vegetative state or death was higher among those patients with cerebral infarction (5.8% versus 1.3%, p<0.03). Conclusions: Cerebral infarction can be infrequently seen in the settings of acute traumatic injury particularly in patients with mass lesions requiring craniotomy.