Azad Tej D, Raj Divyaansh, Ahmed Kowsar, Ran Kathleen, Materi Joshua, Dardick Joseph, Olexa Joshua, Musharbash Farah, Lubelski Daniel, Witham Timothy, Bydon Ali, Theodore Nicholas, Byrne James P, Haut Elliott
Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
World Neurosurg. 2023 Jan;169:e251-e259. doi: 10.1016/j.wneu.2022.10.120. Epub 2022 Nov 2.
Blunt cerebrovascular injury (BCVI), defined as blunt traumatic injury to the carotid or vertebral arteries, is associated with significant risk of stroke and mortality. Cervical spine trauma is a recognized risk factor for BCVI.
The objective of this study was to identify significant predictors of BCVI and its sequelae in patients with known cervical spine injury.
Patients from 2007 to 2018 with blunt cervical spine injury diagnoses were identified in the National Trauma Data Bank. Multivariable logistic regression models were used to identify patient baseline and injury characteristics associated with BCVI, stroke, and mortality.
We identified 229,254 patients with cervical spine injury due to blunt trauma. The overall rate of BCVI was 1.6%. Factors associated with BCVI in patients with cervical spine injury included lower Glasgow Coma Scale, motor vehicle crash, higher Injury Severity Score, concomitant traumatic brain or spinal cord injury, and current smoking status. BCVI was a strong predictor of stroke (odds ratio, 8.2; 95% confidence interval, 5.7-12.0) and was associated with mortality (odds ratio, 1.7; 95% confidence interval, 1.3-2.2). Stroke occurred in 3.3% of patients with BCVI versus 0.02% for patients without BCVI.
While BCVI is rare following cervical spine injury due to blunt trauma, it is a significant predictor of stroke and mortality. The risk factors associated with BCVI, stroke, and mortality identified here should be used in the development of more effective predictive tools to improve care.
钝性脑血管损伤（BCVI）定义为颈动脉或椎动脉的钝性创伤性损伤，与中风和死亡的重大风险相关。颈椎创伤是BCVI的一个公认风险因素。
本研究的目的是确定已知颈椎损伤患者中BCVI及其后遗症的重要预测因素。
在国家创伤数据库中识别2007年至2018年诊断为钝性颈椎损伤的患者。使用多变量逻辑回归模型来识别与BCVI、中风和死亡相关的患者基线和损伤特征。
我们识别出229,254例因钝性创伤导致颈椎损伤的患者。BCVI的总体发生率为1.6%。颈椎损伤患者中与BCVI相关的因素包括较低的格拉斯哥昏迷量表评分、机动车碰撞、较高的损伤严重度评分、并发创伤性脑或脊髓损伤以及当前吸烟状况。BCVI是中风的一个强有力预测因素（比值比，8.2；95%置信区间，5.7 - 12.0），并与死亡率相关（比值比，1.7；95%置信区间，1.3 - 2.2）。BCVI患者中有3.3%发生中风，而无BCVI患者为0.02%。
虽然钝性创伤导致颈椎损伤后BCVI很少见，但它是中风和死亡的一个重要预测因素。此处确定的与BCVI、中风和死亡相关的风险因素应用于开发更有效的预测工具以改善治疗。
