The diagnosis of blunt cerebrovascular injuries (BCVI) has improved with widespread
adaptation of screening protocols and more accurate multi-detector computed tomography
(MDCT-A) angiography. The population at risk and for whom screening is indicated is
still controversial. To help determine which blunt trauma patients would best benefit
from screening we performed a comprehensive analysis of risk factors associated with
BCVI.
All patients with BCVI from June 12, 2000 (the date at which our institution began
screening for these injuries) to June 30, 2009 were identified by the primary author
(JDB) and recorded in a prospective database. Associated injuries were identified
retrospectively by International Classification of Diseases, Ninth Revision (ICD-9)
code and compared with similar patients without BCVI. Demographic information was
also compared from data obtained from the trauma registry. Univariate analyses exploring
associations between individual risk factors and BCVI were performed using Fisher's
exact test for dichotomous variables and Student's t test for continuous variables.
Additionally, relative risk (RR) was calculated for dichotomous variables to describe
the strength of the relationship between the categorical risk factors and BCVI. Multivariate
logistic regression models for BCVI, BCAI (blunt internal carotid artery injury),
and BVAI (blunt vertebral artery injury) were developed to explore the relative contributions
of the various risk factors.
One hundred two patients with BCVI were identified out of 9935 blunt trauma patients
admitted during this time period (1.03% incidence). Fifty-nine patients (0.59% incidence)
had a BVAI and 43 patients (0.43% incidence) had a BCAI. Univariate analysis found
cervical spine fracture (CSI) (RR = 10.4), basilar skull fracture (RR = 3.60), and
mandible fracture (RR = 2.51) to be most predictive of the presence of BCVI (P < .005).
Independent predictors of BCVI on multivariate logistic regression were CSI (OR =
7.46), mandible fracture (OR = 2.59), basilar skull fracture (OR = 1.76), injury severity
score (ISS) (OR = 1.05), and emergency department Glasgow Coma Scale (ED-GCS) (OR
= 0.93): all P < .05.
Blunt trauma patients with a high risk mechanism and a low GCS, high injury severity
score, mandible fracture, basilar skull fracture, or cervical spine injury are at
high risk for BCVI should be screened with MDCT-A.
Copyright 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.