TY - JOUR
T1 - Predictors of Blunt Cerebrovascular Injury, Stroke, and Mortality in Patients with Cervical Spine Trauma
AU - Azad, Tej D.
AU - Raj, Divyaansh
AU - Ahmed, Kowsar
AU - Ran, Kathleen
AU - Materi, Joshua
AU - Dardick, Joseph
AU - Olexa, Joshua
AU - Musharbash, Farah
AU - Lubelski, Daniel
AU - Witham, Timothy
AU - Bydon, Ali
AU - Theodore, Nicholas
AU - Byrne, James P.
AU - Haut, Elliott
N1 - Funding Information:
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/1
Y1 - 2023/1
N2 - 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 cervical 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.
AB - 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 cervical 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.
KW - Blunt cerebrovascular injury
KW - Cervical spine trauma
KW - NTDB
KW - Stroke
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U2 - 10.1016/j.wneu.2022.10.120
DO - 10.1016/j.wneu.2022.10.120
M3 - Article
C2 - 36334717
AN - SCOPUS:85142478267
SN - 1878-8750
VL - 169
SP - e251-e259
JO - World neurosurgery
JF - World neurosurgery
ER -