Carver College of Medicine, University of Iowa, Iowa City, Iowa.
Acute Care Surgery Division, Department of Surgery, University of Iowa, Iowa City, Iowa.
J Surg Res. 2024 Aug;300:63-70. doi: 10.1016/j.jss.2024.04.058. Epub 2024 May 24.
Clinical implications of screening for blunt cerebrovascular injury (BCVI) after low-energy mechanisms of injury (LEMI) remain unclear. We assessed BCVI incidence and outcomes in LEMI versus high-energy mechanisms of injury (HEMI) patients.
In this retrospective cohort study, blunt trauma adults admitted between July 2015 and June 2021 with cervical spine fractures, excluding single spinous process, osteophyte, and chronic fractures were included. Demographics, comorbidities, injuries, screening and treatment data, iatrogenic complications, and mortality were collected. Our primary end point was to compare BCVI rates between LEMI and HEMI patients.
Eight hundred sixty patients (78%) were screened for BCVI; 120 were positive for BCVI. LEMI and HEMI groups presented similar BCVI rates (12.6% versus 14.4%; P = 0.640). Compared to HEMI patients (n = 95), LEMI patients (n = 25) were significantly older (79 ± 14.9 versus 54.3 ± 17.4, P < 0.001), more likely to be on anticoagulants before admission (64% versus 23.2%, P < 0.001), and less severely injured (LEMI injury severity score 10.9 ± 6.6 versus HEMI injury severity score 18.7 ± 11.4, P = 0.001). All but one LEMI and 90.5% of the HEMI patients had vertebral artery injuries with no significant difference in BCVI grades. One HEMI patient developed acute kidney injury because of BCVI screening. Eleven HEMI patients developed BCVI-related stroke with two related mortalities. One LEMI patient died of a BCVI-related stroke.
BCVI rates were similar between HEMI and LEMI groups when screening based on cervical spine fractures. The LEMI group exhibited no screening or treatment complications, suggesting that benefits may outweigh the risks of screening and potential bleeding complications from treatment.
对于低能机制损伤（LEMI）后钝性脑血管损伤（BCVI）的筛查的临床意义仍不清楚。我们评估了 LEMI 与高能机制损伤（HEMI）患者的 BCVI 发生率和结局。
在这项回顾性队列研究中，纳入了 2015 年 7 月至 2021 年 6 月间因颈椎骨折（不包括单个棘突、骨赘和慢性骨折）而入院的钝性创伤成年人。收集了人口统计学、合并症、损伤、筛查和治疗数据、医源性并发症和死亡率。我们的主要终点是比较 LEMI 和 HEMI 患者的 BCVI 发生率。
860 名患者（78%）接受了 BCVI 筛查；120 名患者的 BCVI 阳性。LEMI 和 HEMI 组的 BCVI 发生率相似（12.6%与 14.4%；P=0.640）。与 HEMI 患者（n=95）相比，LEMI 患者（n=25）年龄明显更大（79±14.9 与 54.3±17.4，P<0.001），更有可能在入院前服用抗凝药物（64%与 23.2%，P<0.001），损伤程度较轻（LEMI 损伤严重程度评分 10.9±6.6 与 HEMI 损伤严重程度评分 18.7±11.4，P=0.001）。除了一名 LEMI 患者外，所有患者均有椎动脉损伤，BCVI 分级无显著差异。一名 HEMI 患者因 BCVI 筛查而发生急性肾损伤。11 名 HEMI 患者发生与 BCVI 相关的中风，其中 2 人相关死亡。一名 LEMI 患者死于与 BCVI 相关的中风。
基于颈椎骨折进行筛查时，HEMI 和 LEMI 组的 BCVI 发生率相似。LEMI 组未出现筛查或治疗并发症，这表明筛查的益处可能大于筛查的风险和潜在的治疗出血并发症。
