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Beyond the Usual Suspects: A New Contributor to Blunt Cerebrovascular Injuries
Pharis Sasa
*, Tasneem Zaihra, Eric Mahoney
Lahey Hospital and Medical Center, Waltham, MA
Introduction:
Research into blunt cerebrovascular injuries (BCVI) has found incidence rates between 1-8% depending on screening criteria. Our level 1 trauma center found an unexpected incidence rate of 13.1% on utilization review. The primary objective of this study was to determine predisposing factors in our population that may be correlated with elevated incidents of BCVIs.
Methods:
A retrospective review was performed on our institution’s trauma database for patients who underwent CTA neck as dictated by our liberal screening guidelines in 2023. Cerebrovascular injuries were graded at the time of scan by in-house radiologists and separated into groups based on presence or absence of BCVI. Multivariate logistic regression model with variables which were clinical and/or statistically significant in univariate analyses was fitted
Results:
A total of 305 patients were identified, of whom 40 (13.1%) were identified to have a BCVI. The average age of patients with a BCVI was 56.5 and vertebral artery injuries were more common compared to carotid artery injuries. Patients who had a loss of consciousness (LOC) on scene (OR = 3.35, p < 0.001) or had a concomitant cervical spine fracture (OR = 8.63, p < 0.001) were significantly more likely to also have a BCVI (AUROC =.803, 95% CI [0.7204-0.8862]).
Conclusions:
This study indicates LOC and cervical spine injury provided excellent discriminatory ability for BCVI in an older trauma population. These findings carry clinical significance for adapting BCVI screening guidelines to better care for an aging population.
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