East Texas Medical Center, Tyler, Tex 75701, USA.
J Vasc Surg. 2010 Jan;51(1):57-64. doi: 10.1016/j.jvs.2009.08.071. Epub 2009 Dec 2.
The diagnosis of blunt cerebrovascular injuries (BCVI) has improved with widespread adaptation of screening protocols and more accurate multi-detector computed tomography (MDCT-A) angiography. The population at risk and for whom screening is indicated is still controversial. To help determine which blunt trauma patients would best benefit from screening we performed a comprehensive analysis of risk factors associated with BCVI.
All patients with BCVI from June 12, 2000 (the date at which our institution began screening for these injuries) to June 30, 2009 were identified by the primary author (JDB) and recorded in a prospective database. Associated injuries were identified retrospectively by International Classification of Diseases, Ninth Revision (ICD-9) code and compared with similar patients without BCVI. Demographic information was also compared from data obtained from the trauma registry. Univariate analyses exploring associations between individual risk factors and BCVI were performed using Fisher's exact test for dichotomous variables and Student's t test for continuous variables. Additionally, relative risk (RR) was calculated for dichotomous variables to describe the strength of the relationship between the categorical risk factors and BCVI. Multivariate logistic regression models for BCVI, BCAI (blunt internal carotid artery injury), and BVAI (blunt vertebral artery injury) were developed to explore the relative contributions of the various risk factors.
One hundred two patients with BCVI were identified out of 9935 blunt trauma patients admitted during this time period (1.03% incidence). Fifty-nine patients (0.59% incidence) had a BVAI and 43 patients (0.43% incidence) had a BCAI. Univariate analysis found cervical spine fracture (CSI) (RR = 10.4), basilar skull fracture (RR = 3.60), and mandible fracture (RR = 2.51) to be most predictive of the presence of BCVI (P < .005). Independent predictors of BCVI on multivariate logistic regression were CSI (OR = 7.46), mandible fracture (OR = 2.59), basilar skull fracture (OR = 1.76), injury severity score (ISS) (OR = 1.05), and emergency department Glasgow Coma Scale (ED-GCS) (OR = 0.93): all P < .05.
Blunt trauma patients with a high risk mechanism and a low GCS, high injury severity score, mandible fracture, basilar skull fracture, or cervical spine injury are at high risk for BCVI should be screened with MDCT-A.
随着广泛应用筛选方案和更准确的多探测器计算机断层扫描（MDCT-A）血管造影术，钝性脑血管损伤（BCVI）的诊断得到了改善。风险人群和需要筛选的人群仍存在争议。为了帮助确定哪些钝性创伤患者最能从筛选中受益，我们对与 BCVI 相关的危险因素进行了全面分析。
通过主要作者（JDB）识别 2000 年 6 月 12 日（我们机构开始筛查这些损伤的日期）至 2009 年 6 月 30 日期间所有患有 BCVI 的患者，并将其记录在一个前瞻性数据库中。通过国际疾病分类，第九修订版（ICD-9）代码回顾性确定相关损伤，并与无 BCVI 的类似患者进行比较。人口统计学信息也从创伤登记处获得的数据中进行比较。使用 Fisher 确切检验对二分类变量和学生 t 检验对连续变量进行单变量分析，以探索个体危险因素与 BCVI 之间的关联。对于二分类变量，还计算了相对风险（RR），以描述分类危险因素与 BCVI 之间的关系强度。为 BCVI、BCAI（钝性颈内动脉损伤）和 BVAI（钝性椎动脉损伤）开发了多变量逻辑回归模型，以探索各种危险因素的相对贡献。
在此期间，9935 例钝性创伤患者中发现 102 例患有 BCVI（发生率为 1.03%）。59 例患者（发生率为 0.59%）有 BVAI，43 例患者（发生率为 0.43%）有 BCAI。单变量分析发现颈椎骨折（CSI）（RR = 10.4）、颅底骨折（RR = 3.60）和下颌骨骨折（RR = 2.51）最能预测 BCVI 的存在（P <.005）。多变量逻辑回归的 BCVI 独立预测因子为 CSI（OR = 7.46）、下颌骨骨折（OR = 2.59）、颅底骨折（OR = 1.76）、损伤严重程度评分（ISS）（OR = 1.05）和急诊室格拉斯哥昏迷量表（ED-GCS）（OR = 0.93）：均 P <.05。
具有高风险机制和低 GCS、高损伤严重程度评分、下颌骨骨折、颅底骨折或颈椎损伤的钝性创伤患者应接受 MDCT-A 筛查，以排除 BCVI。
