Predictors of Blunt Cerebrovascular Injury, Stroke, and Mortality in Patients with Cervical Spine Trauma

被引:3
作者
Azad, Tej D. [1 ]
Raj, Divyaansh [1 ]
Ahmed, Kowsar [1 ]
Ran, Kathleen [1 ]
Materi, Joshua [1 ]
Dardick, Joseph [1 ]
Olexa, Joshua [2 ]
Musharbash, Farah [3 ]
Lubelski, Daniel [1 ]
Witham, Timothy [1 ]
Bydon, Ali [1 ]
Theodore, Nicholas [1 ]
Byrne, James P. [4 ]
Haut, Elliott [4 ]
机构
[1] Johns Hopkins Univ Hosp, Dept Neurosurg, Baltimore, MD USA
[2] Univ Maryland, Dept Neurosurg, Med Ctr, Baltimore, MD USA
[3] Johns Hopkins Univ Hosp, Dept Orthoped Surg, Baltimore, MD USA
[4] Johns Hopkins Univ Hosp, Dept Surg, Baltimore, MD 21287 USA
关键词
Blunt cerebrovascular injury; Cervical spine trauma; NTDB; Stroke; SCREENING CRITERIA; EARLY-DIAGNOSIS; ASSOCIATION; MANAGEMENT; FRACTURES; OUTCOMES; THERAPY; SMOKING; DISEASE;
D O I
10.1016/j.wneu.2022.10.120
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: 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.OBJECTIVE: The objective of this study was to identify significant predictors of BCVI and its sequelae in patients with known cervical spine injury.METHODS: Patients from 2007 to 2018 with blunt cervi-cal 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.RESULTS: 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.CONCLUSIONS: 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.
引用
收藏
页码:E251 / E259
页数:9
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