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Risk Factors and Clinical Outcomes Among Adult Patients with Isolated Blunt Cerebrovascular Injuries: A National
Nikita Nunes1, Hazem Nasef, Samuel Baum
1Author Affiliations: NOVA Southeastern University, Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA (Nunes, BS, Patel, MBA, Werling, BSN); NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA (Nasef, BS); Louisiana State University Health Sciences Center, New Orleans, LA, USA (Baum, BS); William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA (Hernandez, BS, Kumar, BS); Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA (Zito, MD, Elkbuli, MD, MPH, MBA); and Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA (Zito, MD, Elkbuli, MD, MPH, MBA).
Background:
Blunt cerebrovascular injury (BCVI) is a rare but serious trauma complication linked to high stroke risk and mortality, often presenting without symptoms and delaying diagnosis. Despite known risk factors, data remain limited on outcomes, especially in patients with concurrent traumatic brain injury (TBI). Additionally, optimal management strategies, particularly for high-grade injuries, remain unclear.
Objective:
The purpose of this study is to evaluate the incidence of BCVI, the associated risk factors, and outcomes for patients with BCVI with or without TBI to improve overall prognosis and outcomes in this patient population.
Methods:
This retrospective cohort analysis utilized the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database (2017-2021). The study population included adult (age ≥ 16 years) blunt trauma patients with Injury Severity Score (ISS) of ≥ 9 and severe isolated (Abbreviated Injury Scale [AIS] head and neck ≥ 3, all other regions < 3) BCVI. Patients were then stratified based on the presence or absence of concomitant mild-moderate TBI (AIS head ≤ 2). Clinical outcomes were compared between BCVI and non-BCVI patients, including incidence of ischemic stroke, mortality rate, intensive care unit length of stay, ventilator-free days, and BCVI risk factors such as cervical spine fracture, mandibular fracture, basilar skull fracture, and presenting Glasgow Coma Scale (GCS) ≤ 8.
Results:
Of 2,172 patients with isolated BCVI, 1,262 (58.1%) had carotid artery injuries and 910 (41.9%) had vertebral artery injuries. Among non-TBI patients, BCVI was significantly associated with cervical spine fractures (OR: 11.60, p < .001), mandibular fractures (OR: 2.87, p < .001), GCS ≤ 8 (OR: 1.65, p = .001), and ischemic stroke (OR: 19.32, p < .001). Among TBI patients, BCVI was significantly associated with cervical spine fractures (OR: 6.79, p < .001), mandibular fractures (OR: 2.10, p < .001), and ischemic stroke (OR: 40.67, p < .001).
Conclusions:
Patients with BCVI had significantly higher odds of presenting with cervical spine and mandibular fractures in addition to ischemic stroke compared to those without BCVI. Understanding the risk factors for BCVI can help guide further investigations and support prompt diagnosis, optimizing care, and improving patient outcomes.
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