Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY.
Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, NY.
Ann Vasc Surg. 2021 Feb;71:157-166. doi: 10.1016/j.avsg.2020.07.031. Epub 2020 Aug 5.
Blunt cerebrovascular injury (BCVI) represents a spectrum of traumatic injuries to the carotid and vertebral arteries that is an often-overlooked source of morbidity and mortality. Its incidence, risk factors, and effect on outcomes in patients with mild or moderate traumatic brain injury (mTBI) have not been studied independently.
The National Trauma Data Bank from 2013 to 2017 was queried to identify patients with mTBI who suffered blunt injuries. BCVI was identified using abbreviated injury scores and included blunt carotid artery injury (BCAI) and blunt vertebral artery injury (BVAI). A binary logistic regression was used to identify patient-related and injury-related factors associated with BCVI. Binary logistic regressions were also performed to evaluate the effect of BCVI on stroke, in-hospital mortality, nonroutine discharge disposition, total length of stay (LOS), intensive care unit LOS, and number of days mechanically ventilated.
Of 485,880 patients with mTBI, there were 4,382 (0.9%) with BCVI. Cervical spine fracture was the strongest factor associated with BCAI (odds ratio [OR], 1.97; 95% confidence interval [95% CI], 1.77-2.19), followed by mandible fracture and basilar skull fracture. Cervical spine fracture also had the strongest association with BVAI (OR, 18.28; 95% CI, 16.47-20.28), followed by spinal cord injury and neck contusion. Stroke was more common in patients with BCAI (OR, 5.50; 95% CI, 4.19-7.21) and BVAI (OR, 7.238; 95% CI, 5.929-8.836). BVAI increased the odds of mortality, but BCAI did not. Both were associated with nonroutine discharge and increased LOS, intensive care unit LOS, and number of days mechanically ventilated.
The incidence of BCVI in patients with mTBI is low, and it usually does not require invasive treatment. However, it is associated with greater odds of stroke and negative outcomes. Knowledge of risk factors for BCVI may tailor further investigation to aid prompt diagnosis.
钝性脑血管损伤（BCVI）是指颈动脉和椎动脉的创伤性损伤，这是发病率和死亡率常常被忽视的一个来源。在轻度或中度创伤性脑损伤（mTBI）患者中，尚未对其发生率、危险因素以及对结局的影响进行独立研究。
从 2013 年至 2017 年，国家创伤数据库中检索出患有 mTBI 并遭受钝性损伤的患者。使用简略损伤评分识别 BCVI，包括钝性颈动脉损伤（BCAI）和钝性椎动脉损伤（BVAI）。使用二元逻辑回归识别与 BCVI 相关的患者相关和损伤相关因素。还进行了二元逻辑回归，以评估 BCVI 对中风、住院死亡率、非常规出院处置、总住院时间（LOS）、重症监护病房 LOS 和机械通气天数的影响。
在 485880 例 mTBI 患者中，有 4382 例（0.9%）患有 BCVI。颈椎骨折是与 BCAI 相关性最强的因素（比值比[OR]，1.97；95%置信区间[95%CI]，1.77-2.19），其次是下颌骨骨折和颅底骨折。颈椎骨折与 BVAI 也具有最强的相关性（OR，18.28；95%CI，16.47-20.28），其次是脊髓损伤和颈部挫伤。BCAI 患者的中风更常见（OR，5.50；95%CI，4.19-7.21）和 BVAI（OR，7.238；95%CI，5.929-8.836）。BVAI 增加了死亡率的可能性，但 BCAI 则没有。两者都与非常规出院和增加 LOS、重症监护病房 LOS 和机械通气天数有关。
mTBI 患者中 BCVI 的发生率较低，通常不需要侵入性治疗。然而，它与更高的中风风险和不良结局相关。了解 BCVI 的危险因素可能有助于进一步调查以协助及时诊断。
