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Challenges in Treatment of Low-Grade Blunt Cerebrovascular Injuries at a Safety-net Hospital.

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Title: Challenges in Treatment of Low-Grade Blunt Cerebrovascular Injuries at a Safety-net Hospital.
Authors: Gochi AM; Department of Surgery, University of California San Francisco-East Bay, Oakland, California. Electronic address: agochi@alamedahealthsystem.org., Ho S; University of California, School of Medicine, San Francisco, California., Sumra S; University of California, School of Medicine, San Francisco, California., Susai CJ; Department of Surgery, University of California San Francisco-East Bay, Oakland, California., Alcasid NJ; Department of Surgery, University of California San Francisco-East Bay, Oakland, California., Barrientos K; Department of Surgery, University of California San Francisco-East Bay, Oakland, California., Gallo KG; Department of Surgery, University of California San Francisco-East Bay, Oakland, California., Victorino GP; Department of Surgery, University of California San Francisco-East Bay, Oakland, California., Gutierrez A; Department of Surgery, University of California San Francisco-East Bay, Oakland, California., Jackson C; Department of Surgery, University of California San Francisco-East Bay, Oakland, California., Beattie G; Department of Surgery, University of California San Francisco-East Bay, Oakland, California., Mendoza AE; Department of Surgery, University of California San Francisco-East Bay, Oakland, California.
Source: The Journal of surgical research [J Surg Res] 2026 Oct; Vol. 326, pp. 391-398. Date of Electronic Publication: 2026 Jul 18.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Academic Press Country of Publication: United States NLM ID: 0376340 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1095-8673 (Electronic) Linking ISSN: 00224804 NLM ISO Abbreviation: J Surg Res Subsets: MEDLINE
Imprint Name(s): Publication: New York, NY : Academic Press
Original Publication: Philadelphia [etc.]
MeSH Terms: Safety-net Providers*/statistics & numerical data , Safety-net Providers*/standards , Cerebrovascular Trauma*/therapy , Cerebrovascular Trauma*/diagnostic imaging , Cerebrovascular Trauma*/diagnosis , Anticoagulants*/therapeutic use , Anticoagulants*/administration & dosage , Wounds, Nonpenetrating*/therapy , Head Injuries, Closed*/therapy , Head Injuries, Closed*/diagnosis, Trauma Centers/statistics & numerical data ; Trauma Centers/standards ; Computed Tomography Angiography/statistics & numerical data ; Platelet Aggregation Inhibitors/therapeutic use ; Guideline Adherence/statistics & numerical data ; Humans ; Male ; Female ; Retrospective Studies ; Adult ; Middle Aged ; Undertreatment ; Injury Severity Score
Abstract: Introduction: Treatment for grade I and II blunt cerebrovascular injuries (BCVIs) involves 3 mo of antiplatelet or anticoagulation therapy with repeat imaging within 7-10 d. We hypothesized that patients at safety-net hospitals often do not complete this regimen, leaving them at risk for cerebrovascular events.
Methods: We performed a retrospective review of patients with grade I-II BCVI at a level 1 trauma center (January 2016-July 2024). Data included timing of initial and repeat computed tomography angiography, initiation, duration, and adherence to medical treatment. Outcomes were completion of repeat imaging and 3-mo medical treatment. Univariate and multivariable analyses were conducted to identify factors associated with treatment completion.
Results: Of 286 patients screened, 38 (30 grade I, 8 grade II) were diagnosed with BCVI. Median age was 44 y, 61% were male, and motor vehicle collision was the most common mechanism (39.5%). Repeat imaging was obtained in 23 patients (60.5%) at a median of 6 d (interquartile range 3-13). Medical treatment was initiated in 32 (84.2%), with 27 (71.1%) discharged on treatment; 12 (44%) completed the 3-mo regimen. No patients obtained 7- to 10-d outpatient imaging, and fewer than half had BCVI addressed in follow-up. On univariate analysis, Hispanic ethnicity (Odds Ratio [OR] 15.6, P = 0.02) and BCVI-specific follow-up (OR 15.0, P = 0.01) were associated with treatment completion. In multivariable analysis, BCVI-specific follow-up remained associated (OR 15.8, P = 0.03).
Conclusions: Adherence to guideline-recommended BCVI therapy and follow-up imaging was poor. Structured discharge pathways and linkage to BCVI-specific follow-up may improve treatment completion.
(Copyright © 2026 Elsevier Inc. All rights reserved.)
Contributed Indexing: Keywords: Blunt cerebrovascular injury; Medical treatment; Safety-net hospital; Treatment adherence; Treatment guidelines
Substance Nomenclature: 0 (Anticoagulants)
0 (Platelet Aggregation Inhibitors)
Entry Date(s): Date Created: 20260718 Date Completed: 20261008 Latest Revision: 20261008
Update Code: 20261008
DOI: 10.1016/j.jss.2026.06.026
PMID: 42470973
Database: MEDLINE
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  Data: Challenges in Treatment of Low-Grade Blunt Cerebrovascular Injuries at a Safety-net Hospital.
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  Data: <searchLink fieldCode="AU" term="%22Gochi+AM%22">Gochi AM</searchLink>; Department of Surgery, University of California San Francisco-East Bay, Oakland, California. Electronic address: agochi@alamedahealthsystem.org.<br /><searchLink fieldCode="AU" term="%22Ho+S%22">Ho S</searchLink>; University of California, School of Medicine, San Francisco, California.<br /><searchLink fieldCode="AU" term="%22Sumra+S%22">Sumra S</searchLink>; University of California, School of Medicine, San Francisco, California.<br /><searchLink fieldCode="AU" term="%22Susai+CJ%22">Susai CJ</searchLink>; Department of Surgery, University of California San Francisco-East Bay, Oakland, California.<br /><searchLink fieldCode="AU" term="%22Alcasid+NJ%22">Alcasid NJ</searchLink>; Department of Surgery, University of California San Francisco-East Bay, Oakland, California.<br /><searchLink fieldCode="AU" term="%22Barrientos+K%22">Barrientos K</searchLink>; Department of Surgery, University of California San Francisco-East Bay, Oakland, California.<br /><searchLink fieldCode="AU" term="%22Gallo+KG%22">Gallo KG</searchLink>; Department of Surgery, University of California San Francisco-East Bay, Oakland, California.<br /><searchLink fieldCode="AU" term="%22Victorino+GP%22">Victorino GP</searchLink>; Department of Surgery, University of California San Francisco-East Bay, Oakland, California.<br /><searchLink fieldCode="AU" term="%22Gutierrez+A%22">Gutierrez A</searchLink>; Department of Surgery, University of California San Francisco-East Bay, Oakland, California.<br /><searchLink fieldCode="AU" term="%22Jackson+C%22">Jackson C</searchLink>; Department of Surgery, University of California San Francisco-East Bay, Oakland, California.<br /><searchLink fieldCode="AU" term="%22Beattie+G%22">Beattie G</searchLink>; Department of Surgery, University of California San Francisco-East Bay, Oakland, California.<br /><searchLink fieldCode="AU" term="%22Mendoza+AE%22">Mendoza AE</searchLink>; Department of Surgery, University of California San Francisco-East Bay, Oakland, California.
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  Data: <searchLink fieldCode="JN" term="%220376340%22">The Journal of surgical research</searchLink> [J Surg Res] 2026 Oct; Vol. 326, pp. 391-398. <i>Date of Electronic Publication: </i>2026 Jul 18.
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Introduction: Treatment for grade I and II blunt cerebrovascular injuries (BCVIs) involves 3 mo of antiplatelet or anticoagulation therapy with repeat imaging within 7-10 d. We hypothesized that patients at safety-net hospitals often do not complete this regimen, leaving them at risk for cerebrovascular events.<br />Methods: We performed a retrospective review of patients with grade I-II BCVI at a level 1 trauma center (January 2016-July 2024). Data included timing of initial and repeat computed tomography angiography, initiation, duration, and adherence to medical treatment. Outcomes were completion of repeat imaging and 3-mo medical treatment. Univariate and multivariable analyses were conducted to identify factors associated with treatment completion.<br />Results: Of 286 patients screened, 38 (30 grade I, 8 grade II) were diagnosed with BCVI. Median age was 44 y, 61% were male, and motor vehicle collision was the most common mechanism (39.5%). Repeat imaging was obtained in 23 patients (60.5%) at a median of 6 d (interquartile range 3-13). Medical treatment was initiated in 32 (84.2%), with 27 (71.1%) discharged on treatment; 12 (44%) completed the 3-mo regimen. No patients obtained 7- to 10-d outpatient imaging, and fewer than half had BCVI addressed in follow-up. On univariate analysis, Hispanic ethnicity (Odds Ratio [OR] 15.6, P = 0.02) and BCVI-specific follow-up (OR 15.0, P = 0.01) were associated with treatment completion. In multivariable analysis, BCVI-specific follow-up remained associated (OR 15.8, P = 0.03).<br />Conclusions: Adherence to guideline-recommended BCVI therapy and follow-up imaging was poor. Structured discharge pathways and linkage to BCVI-specific follow-up may improve treatment completion.<br /> (Copyright © 2026 Elsevier Inc. All rights reserved.)
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