Abstract：
Blunt cervical vascular injury (BCVI) is a non-penetrating trauma to the carotid and/or vertebral vessels following a direct injury to the neck or by the shearing of the cervical vessels. Despite its potentially life-threatening nature, important clinical features of BCVI such as typical patterns of co-occurring injuries for each trauma mechanism are not well known. To address this knowledge gap, we described the characteristics of patients with BCVI to identify the pattern of co-occurring injuries by common trauma mechanisms.
This is a descriptive study using a Japanese nationwide trauma registry from 2004 through 2019. We included patients aged ≥13 years presenting to the emergency department (ED) with BCVI, defined as a blunt trauma to any of the following vessels: common/internal carotid artery, external carotid artery, vertebral artery, external jugular vein, and internal jugular vein. We delineated characteristics of each BCVI classified according to three damaged vessels (common/internal carotid artery, vertebral artery, and others). In addition, we applied network analysis to unravel patterns of co-occurring injuries among patients with BCVI by four common trauma mechanisms (car accident, motorcycle/bicycle accident, simple fall, and fall from a height).
Among 311,692 patients who visited the ED for blunt trauma, 454 (0.1%) patients had BCVI. Patients with common/internal carotid artery injuries presented to the ED with severe symptoms (e.g., the median Glasgow Coma Scale was 7) and had high in-hospital mortality (45%), while patients with vertebral artery injuries presented with relatively stable vital signs. Network analysis showed that head-vertebral-cervical spine injuries were common across four trauma mechanisms (car accident, motorcycle/bicycle accident, simple fall, and fall from a height), with co-occurring injuries of the cervical spine and vertebral artery being the most common injuries due to falls. In addition, common/internal carotid artery injuries were associated with thoracic and abdominal injuries in patients with car accidents.
Based on analyses of a nationwide trauma registry, we found that patients with BCVI had distinct patterns of co-occurring injuries by four trauma mechanisms. Our observations provide an important basis for the initial assessment of blunt trauma and could support the management of BCVI.
This is a descriptive study using a Japanese nationwide trauma registry from 2004 through 2019. We included patients aged ≥13 years presenting to the emergency department (ED) with BCVI, defined as a blunt trauma to any of the following vessels: common/internal carotid artery, external carotid artery, vertebral artery, external jugular vein, and internal jugular vein. We delineated characteristics of each BCVI classified according to three damaged vessels (common/internal carotid artery, vertebral artery, and others). In addition, we applied network analysis to unravel patterns of co-occurring injuries among patients with BCVI by four common trauma mechanisms (car accident, motorcycle/bicycle accident, simple fall, and fall from a height).
Among 311,692 patients who visited the ED for blunt trauma, 454 (0.1%) patients had BCVI. Patients with common/internal carotid artery injuries presented to the ED with severe symptoms (e.g., the median Glasgow Coma Scale was 7) and had high in-hospital mortality (45%), while patients with vertebral artery injuries presented with relatively stable vital signs. Network analysis showed that head-vertebral-cervical spine injuries were common across four trauma mechanisms (car accident, motorcycle/bicycle accident, simple fall, and fall from a height), with co-occurring injuries of the cervical spine and vertebral artery being the most common injuries due to falls. In addition, common/internal carotid artery injuries were associated with thoracic and abdominal injuries in patients with car accidents.
Based on analyses of a nationwide trauma registry, we found that patients with BCVI had distinct patterns of co-occurring injuries by four trauma mechanisms. Our observations provide an important basis for the initial assessment of blunt trauma and could support the management of BCVI.
摘要：
目的：钝性颈部血管损伤（BCVI）是指颈部直接损伤或颈部血管剪切后颈动脉和/或椎管的非穿透性损伤。尽管它有可能危及生命，BCVI的重要临床特征，例如每种创伤机制共同发生损伤的典型模式，尚不为人所知。为了解决这个知识差距，我们描述了BCVI患者的特征,以确定常见创伤机制共同发生的损伤模式.
方法：这是一项描述性研究，使用2004年至2019年的日本全国创伤登记处。我们纳入了年龄≥13岁的急诊（ED）患者，定义为对以下任何血管的钝性创伤：颈总/颈内动脉，颈外动脉,椎动脉,颈外静脉,和颈内静脉.我们根据三个受损血管（颈总动脉/颈内动脉，椎动脉,和其他人）。此外,我们将网络分析应用于通过四种常见创伤机制(车祸，摩托车/自行车事故，简单的秋天，并从高处坠落)。
结果：在311,692例因钝性外伤而就诊的患者中，454例（0.1%）患者有BCVI。患有颈总动脉/颈内动脉损伤的患者出现严重症状（例如，格拉斯哥昏迷评分中位数为7），住院死亡率很高（45％），而椎动脉损伤患者的生命体征相对稳定。网络分析显示，头-脊椎-颈椎损伤在四种创伤机制中是常见的(车祸，摩托车/自行车事故，简单的秋天，并从高处坠落)，颈椎和椎动脉的共同损伤是最常见的跌倒损伤。此外,在车祸患者中,颈总动脉/颈内动脉损伤与胸部和腹部损伤相关.
结论：根据对全国创伤登记的分析，我们发现BCVI患者有4种创伤机制共同发生的不同类型的损伤.我们的观察结果为钝性创伤的初步评估提供了重要依据，并可能支持BCVI的管理。
方法：这是一项描述性研究，使用2004年至2019年的日本全国创伤登记处。我们纳入了年龄≥13岁的急诊（ED）患者，定义为对以下任何血管的钝性创伤：颈总/颈内动脉，颈外动脉,椎动脉,颈外静脉,和颈内静脉.我们根据三个受损血管（颈总动脉/颈内动脉，椎动脉,和其他人）。此外,我们将网络分析应用于通过四种常见创伤机制(车祸，摩托车/自行车事故，简单的秋天，并从高处坠落)。
结果：在311,692例因钝性外伤而就诊的患者中，454例（0.1%）患者有BCVI。患有颈总动脉/颈内动脉损伤的患者出现严重症状（例如，格拉斯哥昏迷评分中位数为7），住院死亡率很高（45％），而椎动脉损伤患者的生命体征相对稳定。网络分析显示，头-脊椎-颈椎损伤在四种创伤机制中是常见的(车祸，摩托车/自行车事故，简单的秋天，并从高处坠落)，颈椎和椎动脉的共同损伤是最常见的跌倒损伤。此外,在车祸患者中,颈总动脉/颈内动脉损伤与胸部和腹部损伤相关.
结论：根据对全国创伤登记的分析，我们发现BCVI患者有4种创伤机制共同发生的不同类型的损伤.我们的观察结果为钝性创伤的初步评估提供了重要依据，并可能支持BCVI的管理。
