Qureshi Adnan I, Sahito Sindhu, Liaqat Jahanzeb, Chandrasekaran Premkumar Nattanmai, Siddiq Farhan
Department of Neurology, University of Missouri, Columbia, MO, USA.
Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA.
J Vasc Interv Neurol. 2020 Jan;11(1):27-33.
The natural history and epidemiological aspects of traumatic injury of major cerebral venous sinuses are not fully understood. We determined the prevalence of traumatic injury of major cerebral venous sinuses and impact on the outcome of patients with traumatic brain injury, and/or 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 thrombosis, intimal tear, or dissection (traumatic injury) of major cerebral venous sinuses was identified in these patients by using Abbreviated Injury Scale predot codes. Admission Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), In-hospital complications, and treatment outcome were compared between patients with and without traumatic injury of major cerebral venous sinuses.
A total of 76 patients were identified with traumatic injury of major cerebral venous sinuses among 453,775 patients who had been admitted with head and neck trauma. The rate of penetrating injury was higher among patients with traumatic injury of major cerebral venous sinuses (11.8% versus 2.5%, = 0.0001). The patients with traumatic injury of major cerebral venous sinuses had a significantly higher rate of intracranial hemorrhage in comparison to patients without traumatic injury of major cerebral venous sinuses. The odds of in-hospital mortality remained significantly higher for patients with traumatic injury of major cerebral venous sinuses after adjusting for age, gender, admission GCS score, ISS injury type, and presence of intracranial hemorrhage [odds ratio (OR): 6.929; 95% confidence interval (CI) 1.337-35.96; p < 0.020]. The odds of discharge to nursing home remained higher for patients with traumatic injury of major cerebral venous sinuses after adjusting for potential confounders (OR: 1.8401; 95% CI 1.18-2.85, < 0.0065).
Although infrequent, traumatic injury of major cerebral venous sinuses in head and neck trauma is associated with higher rates of in-hospital mortality and discharge to a nursing home.
大脑主要静脉窦创伤性损伤的自然史和流行病学特征尚未完全明确。我们确定了大脑主要静脉窦创伤性损伤的患病率及其对创伤性脑损伤和/或头颈部创伤患者预后的影响。
利用2009年至2010年的数据文件，通过国际疾病分类第九版临床修正本（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多个创伤中心的数据。通过使用简明损伤定级预编码，在这些患者中识别大脑主要静脉窦是否存在血栓形成、内膜撕裂或夹层（创伤性损伤）。比较有和没有大脑主要静脉窦创伤性损伤的患者的入院格拉斯哥昏迷量表（GCS）评分、损伤严重度评分（ISS）、住院并发症及治疗结果。
在453775名头颈部创伤入院患者中，共识别出76例大脑主要静脉窦创伤性损伤患者。大脑主要静脉窦创伤性损伤患者的穿透伤发生率更高（11.8%对2.5%，P = 0.0001）。与没有大脑主要静脉窦创伤性损伤的患者相比，大脑主要静脉窦创伤性损伤患者的颅内出血发生率显著更高。在调整年龄、性别、入院GCS评分、ISS损伤类型和颅内出血情况后，大脑主要静脉窦创伤性损伤患者的院内死亡率仍然显著更高[比值比（OR）：6.929；95%置信区间（CI）1.337 - 35.96；P < 0.020]。在调整潜在混杂因素后，大脑主要静脉窦创伤性损伤患者入住疗养院的几率仍然更高（OR：1.8401；95%CI 1.18 - 2.85，P < 0.0065）。
尽管大脑主要静脉窦创伤性损伤在头颈部创伤中并不常见，但与更高的院内死亡率和入住疗养院率相关。
