PIs: Heather J. Fullerton and Christine K. Fox
STATUS: Data Analysis
FUNDING: American Heart Association
Although uncommon relative to stroke in older adults, stroke in the young remains an important challenge because it can lead to lifelong disabilities at an early age. Trauma to cervical or cerebral arteries is a well known cause of stroke in the young; physicians in trauma centers have long faced the challenge of preventing these strokes. Among patients presenting to trauma centers, the short term risk of stroke is at least 0.18%: ≈1.5% have evidence of BCVI on vascular imaging, and 12% of those with BCVI will go on to have a stroke (1.5% x 12%=0.18%). Investigators have struggled to (1) identify trauma patients at high-risk for BCVI; (2) develop screening criteria for vascular imaging to detect BCVI; (3) determine the most sensitive and specific imaging modality for BCVI screening; and (4) determine the optimal intervention for primary stroke prevention in patients found to have BCVI. The last objective—optimal treatment—has been the least controversial. Antithrombotic therapy (i.e., anti-platelets like aspirin, or anticoagulants, like warfarin or heparin) has long been considered standard of care for primary or secondary stroke prevention in the setting of arterial dissection (spontaneous or traumatic) and BCVI in general. Recent observational data suggest that aspirin may be as effective as anticoagulation, making it increasingly favored as a first line therapy given its greater ease of dosing and administration. Both forms of antithrombotics are relatively safe, with bleeding complications in <1%, although they are considered contraindicated in up to 30% of patients diagnosed with BCVI in a trauma center: those with severe traumatic brain injury, visceral trauma, or multiple orthopedic injuries.
We performed preliminary searches of KPNC databases to estimate the size of the trauma cohort that will be identified for the first two aims of this study. From 1/1997 through 12/2008, there were a total of 613,854 subjects under 50 years of age with at least one outpatient visit or hospital admission for trauma (an average of 55,805 subjects per study year). This value includes out-of-system medical encounters. Of these, 257,257 were children (<20 years of age) and 356,597 were adults. By extending the cohort through 12/2010, our total cohort should include >700,000 subjects.