Majidi Shahram, Hassan Ameer E, Adil Malik M, Jadhav Vikram, Qureshi Adnan I
Department of Neurology, The George Washington University, 2150 Pennsylvania Avenue NW, 9th Floor, Washington, DC, 20037, USA,
Neurocrit Care. 2014 Oct;21(2):253-8. doi: 10.1007/s12028-013-9937-8.
The natural history and epidemiological aspects of traumatic vertebral artery dissection (VAD) are not fully understood. We determined the prevalence of VAD and impact on outcome of patients with head and neck trauma.
All the patients who were admitted with traumatic brain injury or head and neck trauma were identified by ICD-9-CM codes from the National Trauma Data Bank (NTDB), using data files from 2009 to 2010. NTDB represents one of the largest trauma databases and contains data from over 900 trauma centers across the United States. Presence of VAD was identified in these patients by using ICD-9-CM codes. Admission Glasgow Coma Scale (GCS) score, injury severity score (ISS), in-hospital complications, and treatment outcome were compared between patients with and without VAD.
A total of 84 VAD patients were identified which comprised 0.01 % of all patients admitted with head and neck trauma. The mean age (in years) for patients with VAD was significantly higher than patients without dissection [46 (95 % CI 41-50) vs. 41.3 (95 % CI 41.2-41.4); p = 0.003]. The proportion of patients presenting with GCS score <9 was significantly higher in patients with VAD (31 vs. 12 %, p < 0.0001). The rate of cervical vertebral fracture was significantly higher in patients with VAD (71 vs. 11 %, p < 0.0001). Patients with VAD had higher rates of in-hospital stroke than patients without dissection (5 vs. 0.2 %, p < 0.0001). Numbers of ICU days, ventilator days, and hospital length of stays were all significantly higher in patients with VAD. These differences remained significant after adjusting for the demographics, admission GCS score, and ISS (p < 0.0001). A total of 7 % (N = 6) of the patients with VAD received endovascular treatment and there was no in-hospital stroke in these patients. Patients with VAD had a higher chance of discharge to nursing facilities in comparison to head trauma patients without VAD (OR: 2.1; 95 % CI 1.4-3.5; p < 0.0001).
Although infrequent, VAD in head and neck trauma is associated with higher rates of in-hospital stroke and longer length of ICU stay and total hospital stay. Early diagnosis and endovascular treatment may be an alternative option to reduce the rate of in-hospital stroke in these patients.
创伤性椎动脉夹层（VAD）的自然病史和流行病学特征尚未完全明确。我们确定了VAD的患病率及其对头部和颈部创伤患者预后的影响。
利用2009年至2010年的数据库文件，通过国际疾病分类第九版临床修正版（ICD - 9 - CM）编码，从国家创伤数据库（NTDB）中识别出所有因创伤性脑损伤或头部和颈部创伤入院的患者。NTDB是最大的创伤数据库之一，包含来自美国900多家创伤中心的数据。通过ICD - 9 - CM编码在这些患者中确定VAD的存在。比较有和没有VAD的患者的入院格拉斯哥昏迷量表（GCS）评分、损伤严重程度评分（ISS）、院内并发症及治疗结果。
共识别出84例VAD患者，占所有头部和颈部创伤入院患者的0.01％。VAD患者的平均年龄（岁）显著高于未发生夹层的患者[46（95％CI 41 - 50）对41.3（95％CI 41.2 - 41.4）；p = 0.003]。VAD患者中GCS评分<9的患者比例显著更高（31％对12％，p <0.0001）。VAD患者颈椎骨折的发生率显著更高（71％对11％，p <0.0001）。VAD患者的院内卒中发生率高于未发生夹层的患者（5％对0.2％，p <0.0001）。VAD患者的ICU天数、呼吸机使用天数和住院时间均显著更长。在调整人口统计学、入院GCS评分和ISS后，这些差异仍然显著（p <0.0001）。共有7％（N = 6）的VAD患者接受了血管内治疗，这些患者中没有发生院内卒中。与没有VAD的头部创伤患者相比，VAD患者出院到护理机构中的可能性更高（OR：2.1；95％CI 1.4 - 3.5；p <0.0001）。
虽然罕见，但头部和颈部创伤中的VAD与更高的院内卒中发生率以及更长的ICU住院时间和总住院时间相关。早期诊断和血管内治疗可能是降低这些患者院内卒中发生率的一种替代选择。
