Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213 USA.
World J Emerg Surg. 2018 Jul 4;13:30. doi: 10.1186/s13017-018-0188-z. eCollection 2018.
Blunt cerebrovascular injuries (BCVI) are generally associated with high-energy injury mechanisms. Less is known regarding lower-energy injuries in elderly patients. We sought to determine the incidence of BCVI and characterize current BCVI screening practices and associated complications in elderly ground-level fall patients (EGLF, ≥ 65 years). We hypothesized that BCVI in EGLF patients would be clinically significant and screening would be less common.
A retrospective study was performed utilizing the National Trauma Data Bank (NTDB, 2007-2014) and single institutional data. BCVI risk factors and diagnosis were determined by ICD-9 codes. Presenting patient characteristics and clinical course were obtained by chart review. The NTDB dataset was used to determine the incidence of BCVI, risk factors for BCVI, and outcomes in the EGLF cohort. Local chart review focused on screening rates and complications.
The incidence of BCVI in EGLF patients was 0.15% overall and 0.86% in those with at least one BCVI risk factor in the NTDB. Upper cervical spine fractures were the most common risk factor for BCVI in EGLF patients. In EGLF patients, the diagnosis of BCVI was an independent risk factor for mortality (OR1.8, 95% C.I. 1.5-2.1). The local institutional data (2007-2014) had a BCVI incidence of 0.37% ( = 6487) and 1.47% in those with at least one risk factor ( = 1429). EGLF patients with a risk factor for BCVI had a very low rate of screening (44%). Only 8% of EGLF patients not screened had documented contraindications. The incidence of renal injury was 9% irrespective of BCVI screening.
The incidence of BCVI is clinically significant in EGLF patients and an independent predictor of mortality. Screening is less common in EGLF patients despite few contraindications. This data suggests that using age and injury mechanism to omit BCVI screening in EGLF patients may exclude an at-risk population.
IRB approval number: PRO15020269. Retrospective trial not registered.
钝性脑血管损伤（BCVI）通常与高能损伤机制有关。对于老年患者的低能量损伤，人们了解较少。我们旨在确定老年人地面水平跌倒患者（EGLF，≥65 岁）中 BCVI 的发生率，并描述当前 BCVI 筛查实践及相关并发症。我们假设 EGLF 患者的 BCVI 具有临床意义，且筛查不常见。
利用国家创伤数据库（NTDB，2007-2014 年）和单机构数据进行回顾性研究。通过 ICD-9 代码确定 BCVI 的危险因素和诊断。通过病历回顾获取患者的临床表现和临床病程。NTDB 数据集用于确定 EGLF 队列中 BCVI 的发生率、BCVI 的危险因素和结局。本地图表审查重点在于筛查率和并发症。
NTDB 中 EGLF 患者的 BCVI 发生率总体为 0.15%，至少有一个 BCVI 危险因素的患者为 0.86%。颈椎上部骨折是 EGLF 患者发生 BCVI 的最常见危险因素。在 EGLF 患者中，BCVI 的诊断是死亡率的独立危险因素（OR1.8，95%CI1.5-2.1）。本地机构数据（2007-2014 年）BCVI 发生率为 0.37%（ = 6487），至少有一个危险因素的发生率为 1.47%（ = 1429）。有 BCVI 危险因素的 EGLF 患者的筛查率非常低（44%）。没有进行筛查的 EGLF 患者中，仅有 8%有明确的禁忌证。无论是否进行 BCVI 筛查，肾损伤的发生率均为 9%。
BCVI 在 EGLF 患者中有临床意义，是死亡率的独立预测因素。尽管禁忌证较少，但 EGLF 患者的筛查并不常见。这些数据表明，使用年龄和损伤机制排除 EGLF 患者的 BCVI 筛查可能会遗漏高危人群。
IRB 批准号：PRO15020269。回顾性试验未注册。
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