TY - JOUR
T1 - Incidence and Outcome of Vertebral Artery Dissection in Trauma Setting
T2 - Analysis of National Trauma Data Base
AU - Majidi, Shahram
AU - Hassan, Ameer E.
AU - Adil, Malik M.
AU - Jadhav, Vikram
AU - Qureshi, Adnan I.
N1 - Funding Information:
Acknowledgment Dr. Majidi is supported by American Heart Association Clinical Research Program Award 13CRP17330020, Brain Edema at Cerebral Hemorrhage (BEACH) study. Dr. Qureshi is supported by National Institute of Neurological Diseases and Stroke. Principal Investigator, Antihypertensive Treatment in Acute Cerebral Hemorrhage (ATACH)-II. 1R01NS062091-01A2 (medication provided by EKR therapeutics) and American Heart Association Established Investigator Award 0840053N, Innovative Strategies for Treating Cerebral Hemorrhage.
Publisher Copyright:
© 2014, Springer Science+Business Media New York.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Background: The natural history and epidemiological aspects of traumatic vertebral artery dissection (VAD) are not fully understood. We determined the prevalence of VAD and impact on outcome of patients with head and neck trauma.Methods: All the patients who were admitted with traumatic brain injury or head and neck trauma were identified by ICD-9-CM codes from the National Trauma Data Bank (NTDB), using data files from 2009 to 2010. NTDB represents one of the largest trauma databases and contains data from over 900 trauma centers across the United States. Presence of VAD was identified in these patients by using ICD-9-CM codes. Admission Glasgow Coma Scale (GCS) score, injury severity score (ISS), in-hospital complications, and treatment outcome were compared between patients with and without VAD.Results: A total of 84 VAD patients were identified which comprised 0.01 % of all patients admitted with head and neck trauma. The mean age (in years) for patients with VAD was significantly higher than patients without dissection [46 (95 % CI 41–50) vs. 41.3 (95 % CI 41.2–41.4); p = 0.003]. The proportion of patients presenting with GCS score <9 was significantly higher in patients with VAD (31 vs. 12 %, p < 0.0001). The rate of cervical vertebral fracture was significantly higher in patients with VAD (71 vs. 11 %, p < 0.0001). Patients with VAD had higher rates of in-hospital stroke than patients without dissection (5 vs. 0.2 %, p < 0.0001). Numbers of ICU days, ventilator days, and hospital length of stays were all significantly higher in patients with VAD. These differences remained significant after adjusting for the demographics, admission GCS score, and ISS (p < 0.0001). A total of 7 % (N = 6) of the patients with VAD received endovascular treatment and there was no in-hospital stroke in these patients. Patients with VAD had a higher chance of discharge to nursing facilities in comparison to head trauma patients without VAD (OR: 2.1; 95 % CI 1.4–3.5; p < 0.0001).Conclusion: Although infrequent, VAD in head and neck trauma is associated with higher rates of in-hospital stroke and longer length of ICU stay and total hospital stay. Early diagnosis and endovascular treatment may be an alternative option to reduce the rate of in-hospital stroke in these patients.
AB - Background: The natural history and epidemiological aspects of traumatic vertebral artery dissection (VAD) are not fully understood. We determined the prevalence of VAD and impact on outcome of patients with head and neck trauma.Methods: All the patients who were admitted with traumatic brain injury or head and neck trauma were identified by ICD-9-CM codes from the National Trauma Data Bank (NTDB), using data files from 2009 to 2010. NTDB represents one of the largest trauma databases and contains data from over 900 trauma centers across the United States. Presence of VAD was identified in these patients by using ICD-9-CM codes. Admission Glasgow Coma Scale (GCS) score, injury severity score (ISS), in-hospital complications, and treatment outcome were compared between patients with and without VAD.Results: A total of 84 VAD patients were identified which comprised 0.01 % of all patients admitted with head and neck trauma. The mean age (in years) for patients with VAD was significantly higher than patients without dissection [46 (95 % CI 41–50) vs. 41.3 (95 % CI 41.2–41.4); p = 0.003]. The proportion of patients presenting with GCS score <9 was significantly higher in patients with VAD (31 vs. 12 %, p < 0.0001). The rate of cervical vertebral fracture was significantly higher in patients with VAD (71 vs. 11 %, p < 0.0001). Patients with VAD had higher rates of in-hospital stroke than patients without dissection (5 vs. 0.2 %, p < 0.0001). Numbers of ICU days, ventilator days, and hospital length of stays were all significantly higher in patients with VAD. These differences remained significant after adjusting for the demographics, admission GCS score, and ISS (p < 0.0001). A total of 7 % (N = 6) of the patients with VAD received endovascular treatment and there was no in-hospital stroke in these patients. Patients with VAD had a higher chance of discharge to nursing facilities in comparison to head trauma patients without VAD (OR: 2.1; 95 % CI 1.4–3.5; p < 0.0001).Conclusion: Although infrequent, VAD in head and neck trauma is associated with higher rates of in-hospital stroke and longer length of ICU stay and total hospital stay. Early diagnosis and endovascular treatment may be an alternative option to reduce the rate of in-hospital stroke in these patients.
KW - Endovascular treatment
KW - Head trauma
KW - Stroke
KW - Vertebral artery dissection
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U2 - 10.1007/s12028-013-9937-8
DO - 10.1007/s12028-013-9937-8
M3 - Article
C2 - 24549934
AN - SCOPUS:84911001907
SN - 1541-6933
VL - 21
SP - 253
EP - 258
JO - Neurocritical care
JF - Neurocritical care
IS - 2
ER -