Abstract：
OBJECTIVE: There is a lack of data on the role of characteristics of injured vessels on the outcomes of patients with blunt cerebrovascular injuries (BCVIs). The aim of this study was to assess the effect of the number (single vs multiple) of injured vessels on outcomes.
METHODS: This is a retrospective study at two American College of Surgeons Level I trauma centers (2017-2021). Adult (>16 years) trauma patients with BCVIs are included. Injuries were graded by the Denver Scale based on the initial computed tomography angiography (CTA). Early repeat CTA was performed 7 to 10 days after diagnosis. Patients were stratified by the number (single vs multiple) of the involved vessels. Outcomes included progression of BCVIs on repeat CTA, stroke, and in-hospital mortality attributable to BCVIs. Multivariable regression analyses were performed to identify the association between the number of injured vessels and outcomes.
RESULTS: A total of 491 patients with 591 injured vessels (285 carotid and 306 vertebral arteries) were identified. Sixty percent were male, the mean age was 44 years, and the median Injury Severity Score was 18 (interquartile range, 11-25). Overall, 18% had multiple-vessel injuries, 16% had bilateral vessel injuries, and 3% had multiple injuries on the same side. The overall rates of progression to higher-grade injuries, stroke, and mortality were 23%, 7.7%, and 8.8%, respectively. On uni- and multivariable analyses, multiple BCVIs were associated with progression to higher-grade injuries on repeat imaging, stroke, and mortality compared with single-vessel injuries.
CONCLUSIONS: BCVIs with multiple injured vessels are more likely to progress to higher grades on repeat CTA, with multiple injuries independently associated with worse clinical outcomes, compared with those with single injuries. These findings highlight the importance of incorporating the number of injured vessels in clinical decision-making and in defining protocols for repeat imaging.
METHODS: This is a retrospective study at two American College of Surgeons Level I trauma centers (2017-2021). Adult (>16 years) trauma patients with BCVIs are included. Injuries were graded by the Denver Scale based on the initial computed tomography angiography (CTA). Early repeat CTA was performed 7 to 10 days after diagnosis. Patients were stratified by the number (single vs multiple) of the involved vessels. Outcomes included progression of BCVIs on repeat CTA, stroke, and in-hospital mortality attributable to BCVIs. Multivariable regression analyses were performed to identify the association between the number of injured vessels and outcomes.
RESULTS: A total of 491 patients with 591 injured vessels (285 carotid and 306 vertebral arteries) were identified. Sixty percent were male, the mean age was 44 years, and the median Injury Severity Score was 18 (interquartile range, 11-25). Overall, 18% had multiple-vessel injuries, 16% had bilateral vessel injuries, and 3% had multiple injuries on the same side. The overall rates of progression to higher-grade injuries, stroke, and mortality were 23%, 7.7%, and 8.8%, respectively. On uni- and multivariable analyses, multiple BCVIs were associated with progression to higher-grade injuries on repeat imaging, stroke, and mortality compared with single-vessel injuries.
CONCLUSIONS: BCVIs with multiple injured vessels are more likely to progress to higher grades on repeat CTA, with multiple injuries independently associated with worse clinical outcomes, compared with those with single injuries. These findings highlight the importance of incorporating the number of injured vessels in clinical decision-making and in defining protocols for repeat imaging.
摘要：
目的：缺乏关于损伤血管特征对钝性脑血管损伤（BCVIs）患者预后的作用的数据。这项研究的目的是评估受伤血管的数量（单个与多个）对结果的影响。
方法：这是两个ACSI级创伤中心（2017-2021年）的回顾性研究。包括患有BCVI的成年（>16年）创伤患者。根据最初的计算机断层扫描血管造影（CTA），按照丹佛量表对损伤进行分级。诊断后7-10天进行早期重复CTA。患者按数量分层(Singlevs.多个)涉及的船只。结果包括重复CTA的BCVI进展，中风,以及可归因于BCVI的院内死亡率。进行多变量回归分析以确定损伤血管数量与结果之间的关联。
结果：确定了491例患者，其中591条血管受损（285条颈动脉和306条椎动脉）。60%是男性,平均年龄是44岁,ISS中位数为18[11-25]。总的来说,18%的人有多血管损伤,16%有双侧血管损伤，3%的人在同一侧多处受伤。进展到更高级别伤害的总体比率，中风,死亡率为23%，7.7%,和8.8%，分别。在单变量和多变量分析中，多次BCVIs与重复成像时进展为高级别损伤相关,中风,与单血管损伤相比，死亡率。
结论：多血管损伤的BCVIs在重复CTA时更有可能进展到更高等级，多发性损伤与更差的临床结果独立相关，与那些受伤的人相比。这些发现强调了在临床决策和定义重复成像方案中纳入受伤血管数量的重要性。
方法：这是两个ACSI级创伤中心（2017-2021年）的回顾性研究。包括患有BCVI的成年（>16年）创伤患者。根据最初的计算机断层扫描血管造影（CTA），按照丹佛量表对损伤进行分级。诊断后7-10天进行早期重复CTA。患者按数量分层(Singlevs.多个)涉及的船只。结果包括重复CTA的BCVI进展，中风,以及可归因于BCVI的院内死亡率。进行多变量回归分析以确定损伤血管数量与结果之间的关联。
结果：确定了491例患者，其中591条血管受损（285条颈动脉和306条椎动脉）。60%是男性,平均年龄是44岁,ISS中位数为18[11-25]。总的来说,18%的人有多血管损伤,16%有双侧血管损伤，3%的人在同一侧多处受伤。进展到更高级别伤害的总体比率，中风,死亡率为23%，7.7%,和8.8%，分别。在单变量和多变量分析中，多次BCVIs与重复成像时进展为高级别损伤相关,中风,与单血管损伤相比，死亡率。
结论：多血管损伤的BCVIs在重复CTA时更有可能进展到更高等级，多发性损伤与更差的临床结果独立相关，与那些受伤的人相比。这些发现强调了在临床决策和定义重复成像方案中纳入受伤血管数量的重要性。
