Abstract：
OBJECTIVE: Blunt cerebrovascular injury (BCVI) includes carotid and/or vertebral artery injury following trauma, and conveys an increased stroke risk. We conducted a systematic review and meta-analysis to provide a comprehensive summary of prognostic factors associated with risk of stroke following BCVI.
METHODS: We searched the EMBASE and MEDLINE databases from January 1946 to June 2023. We identified studies reporting associations between patient or injury factors and risk of stroke following BCVI. We performed meta-analyses of odds ratios (ORs) using the random effects method and assessed individual study risk of bias using the QUIPS tool. We separately pooled adjusted and unadjusted analyses, highlighting the estimate with the higher certainty.
RESULTS: We included 26 cohort studies, involving 20,458 patients with blunt trauma. The overall incidence of stroke following BCVI was 7.7 %. Studies were predominantly retrospective cohorts from North America and included both carotid and vertebral artery injuries. Diagnosis of BCVI was most commonly confirmed with CT angiography. We demonstrated with moderate to high certainty that factors associated with increased risk of stroke included carotid artery injury (as compared to vertebral artery injury, unadjusted odds ratio [uOR] 1.94, 95 % CI 1.62 to 2.32), Grade III Injury (as compared to grade I or II) (uOR 2.45, 95 % CI 1.88 to 3.20), Grade IV injury (uOR 3.09, 95 % CI 2.20 to 4.35), polyarterial injury (uOR 3.11 (95 % CI 2.05 to 4.72), occurrence of hypotension at the time of hospital admission (adjusted odds ratio [aOR] 1.32, 95 % CI 0.87 to 2.03) and higher total body injury severity (aOR 5.91, 95 % CI 1.90 to 18.39).
CONCLUSIONS: Local anatomical injury pattern, overall burden of injury and flow dynamics contribute to BCVI-related stroke risk. These findings provide the foundational evidence base for risk stratification to support clinical decision making and further research.
METHODS: We searched the EMBASE and MEDLINE databases from January 1946 to June 2023. We identified studies reporting associations between patient or injury factors and risk of stroke following BCVI. We performed meta-analyses of odds ratios (ORs) using the random effects method and assessed individual study risk of bias using the QUIPS tool. We separately pooled adjusted and unadjusted analyses, highlighting the estimate with the higher certainty.
RESULTS: We included 26 cohort studies, involving 20,458 patients with blunt trauma. The overall incidence of stroke following BCVI was 7.7 %. Studies were predominantly retrospective cohorts from North America and included both carotid and vertebral artery injuries. Diagnosis of BCVI was most commonly confirmed with CT angiography. We demonstrated with moderate to high certainty that factors associated with increased risk of stroke included carotid artery injury (as compared to vertebral artery injury, unadjusted odds ratio [uOR] 1.94, 95 % CI 1.62 to 2.32), Grade III Injury (as compared to grade I or II) (uOR 2.45, 95 % CI 1.88 to 3.20), Grade IV injury (uOR 3.09, 95 % CI 2.20 to 4.35), polyarterial injury (uOR 3.11 (95 % CI 2.05 to 4.72), occurrence of hypotension at the time of hospital admission (adjusted odds ratio [aOR] 1.32, 95 % CI 0.87 to 2.03) and higher total body injury severity (aOR 5.91, 95 % CI 1.90 to 18.39).
CONCLUSIONS: Local anatomical injury pattern, overall burden of injury and flow dynamics contribute to BCVI-related stroke risk. These findings provide the foundational evidence base for risk stratification to support clinical decision making and further research.
摘要：
目的：钝性脑血管损伤（BCVI）包括外伤后的颈动脉和/或椎动脉损伤，并传达中风风险增加。我们进行了系统评价和荟萃分析，以全面总结与BCVI后卒中风险相关的预后因素。
方法：我们检索了1946年1月至2023年6月的EMBASE和MEDLINE数据库。我们确定了报告患者或损伤因素与BCVI后卒中风险之间关联的研究。我们使用随机效应方法对比值比（OR）进行荟萃分析，并使用QUIPS工具评估个体研究偏倚风险。我们分别汇总了调整后和未调整后的分析，以更高的确定性突出估计。
结果：我们纳入了26项队列研究，涉及20,458例钝性外伤患者.BCVI后卒中的总发生率为7.7%。研究主要是来自北美的回顾性队列，包括颈动脉和椎动脉损伤。BCVI的诊断最常见于CT血管造影。我们以中至高的确定性证明，与卒中风险增加相关的因素包括颈动脉损伤（与椎动脉损伤相比，未调整的赔率比[UOR]1.94，95%CI1.62至2.32)，III级伤害（与I级或II级相比）（uOR2.45，95%CI1.88至3.20），IV级伤害（UOR3.09，95%CI2.20至4.35），多动脉损伤(UOR3.11(95%CI2.05至4.72)，入院时低血压的发生(校正比值比[aOR]1.32,95%CI0.87~2.03)和更高的全身损伤严重程度(aOR5.91,95%CI1.90~18.39).
结论：局部解剖损伤模式，总体损伤负担和血流动力学导致BCVI相关卒中风险.这些发现为风险分层提供了基础证据，以支持临床决策和进一步研究。
方法：我们检索了1946年1月至2023年6月的EMBASE和MEDLINE数据库。我们确定了报告患者或损伤因素与BCVI后卒中风险之间关联的研究。我们使用随机效应方法对比值比（OR）进行荟萃分析，并使用QUIPS工具评估个体研究偏倚风险。我们分别汇总了调整后和未调整后的分析，以更高的确定性突出估计。
结果：我们纳入了26项队列研究，涉及20,458例钝性外伤患者.BCVI后卒中的总发生率为7.7%。研究主要是来自北美的回顾性队列，包括颈动脉和椎动脉损伤。BCVI的诊断最常见于CT血管造影。我们以中至高的确定性证明，与卒中风险增加相关的因素包括颈动脉损伤（与椎动脉损伤相比，未调整的赔率比[UOR]1.94，95%CI1.62至2.32)，III级伤害（与I级或II级相比）（uOR2.45，95%CI1.88至3.20），IV级伤害（UOR3.09，95%CI2.20至4.35），多动脉损伤(UOR3.11(95%CI2.05至4.72)，入院时低血压的发生(校正比值比[aOR]1.32,95%CI0.87~2.03)和更高的全身损伤严重程度(aOR5.91,95%CI1.90~18.39).
结论：局部解剖损伤模式，总体损伤负担和血流动力学导致BCVI相关卒中风险.这些发现为风险分层提供了基础证据，以支持临床决策和进一步研究。
