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Abstract：
BACKGROUND: Clinical implications of screening for blunt cerebrovascular injury (BCVI) after low-energy mechanisms of injury (LEMI) remain unclear. We assessed BCVI incidence and outcomes in LEMI versus high-energy mechanisms of injury (HEMI) patients.
METHODS: In this retrospective cohort study, blunt trauma adults admitted between July 2015 and June 2021 with cervical spine fractures, excluding single spinous process, osteophyte, and chronic fractures were included. Demographics, comorbidities, injuries, screening and treatment data, iatrogenic complications, and mortality were collected. Our primary end point was to compare BCVI rates between LEMI and HEMI patients.
RESULTS: Eight hundred sixty patients (78%) were screened for BCVI; 120 were positive for BCVI. LEMI and HEMI groups presented similar BCVI rates (12.6% versus 14.4%; P = 0.640). Compared to HEMI patients (n = 95), LEMI patients (n = 25) were significantly older (79 ± 14.9 versus 54.3 ± 17.4, P < 0.001), more likely to be on anticoagulants before admission (64% versus 23.2%, P < 0.001), and less severely injured (LEMI injury severity score 10.9 ± 6.6 versus HEMI injury severity score 18.7 ± 11.4, P = 0.001). All but one LEMI and 90.5% of the HEMI patients had vertebral artery injuries with no significant difference in BCVI grades. One HEMI patient developed acute kidney injury because of BCVI screening. Eleven HEMI patients developed BCVI-related stroke with two related mortalities. One LEMI patient died of a BCVI-related stroke.
CONCLUSIONS: BCVI rates were similar between HEMI and LEMI groups when screening based on cervical spine fractures. The LEMI group exhibited no screening or treatment complications, suggesting that benefits may outweigh the risks of screening and potential bleeding complications from treatment.
METHODS: In this retrospective cohort study, blunt trauma adults admitted between July 2015 and June 2021 with cervical spine fractures, excluding single spinous process, osteophyte, and chronic fractures were included. Demographics, comorbidities, injuries, screening and treatment data, iatrogenic complications, and mortality were collected. Our primary end point was to compare BCVI rates between LEMI and HEMI patients.
RESULTS: Eight hundred sixty patients (78%) were screened for BCVI; 120 were positive for BCVI. LEMI and HEMI groups presented similar BCVI rates (12.6% versus 14.4%; P = 0.640). Compared to HEMI patients (n = 95), LEMI patients (n = 25) were significantly older (79 ± 14.9 versus 54.3 ± 17.4, P < 0.001), more likely to be on anticoagulants before admission (64% versus 23.2%, P < 0.001), and less severely injured (LEMI injury severity score 10.9 ± 6.6 versus HEMI injury severity score 18.7 ± 11.4, P = 0.001). All but one LEMI and 90.5% of the HEMI patients had vertebral artery injuries with no significant difference in BCVI grades. One HEMI patient developed acute kidney injury because of BCVI screening. Eleven HEMI patients developed BCVI-related stroke with two related mortalities. One LEMI patient died of a BCVI-related stroke.
CONCLUSIONS: BCVI rates were similar between HEMI and LEMI groups when screening based on cervical spine fractures. The LEMI group exhibited no screening or treatment complications, suggesting that benefits may outweigh the risks of screening and potential bleeding complications from treatment.
摘要：
背景：在低能量损伤机制（LEMI）后筛查钝性脑血管损伤（BCVI）的临床意义尚不清楚。我们评估了LEMI与高能损伤机制（HEMI）患者的BCVI发生率和预后。
方法：在这项回顾性队列研究中，2015年7月至2021年6月期间收治的钝性外伤成人颈椎骨折，不包括单个棘突，骨赘,包括慢性骨折。人口统计,合并症,受伤,筛查和治疗数据，医源性并发症，和死亡率被收集。我们的主要终点是比较LEMI和HEMI患者的BCVI率。
结果：八百六十例患者（78%）进行了BCVI筛查；120例BCVI阳性。LEMI组和HEMI组的BCVI发生率相似(12.6%对14.4%;P=0.640)。与HEMI患者（n=95）相比，LEMI患者（n=25）明显年龄较大（79±14.9对54.3±17.4，P<0.001），入院前服用抗凝剂的可能性更大(64%对23.2%，P<0.001)，和较不严重的损伤（LEMI损伤严重程度评分10.9±6.6与HEMI损伤严重程度评分18.7±11.4，P=0.001）。除一名LEMI和90.5％的HEMI患者外，所有患者均有椎动脉损伤，BCVI等级无显着差异。一名HEMI患者由于BCVI筛查而出现急性肾损伤。11例HEMI患者发生BCVI相关卒中，有2例相关死亡率。一名LEMI患者死于BCVI相关卒中。
结论：根据颈椎骨折进行筛查时，HEMI和LEMI组的BCVI发生率相似。LEMI组无筛查或治疗并发症，提示治疗带来的益处可能大于筛查和潜在出血并发症的风险.
方法：在这项回顾性队列研究中，2015年7月至2021年6月期间收治的钝性外伤成人颈椎骨折，不包括单个棘突，骨赘,包括慢性骨折。人口统计,合并症,受伤,筛查和治疗数据，医源性并发症，和死亡率被收集。我们的主要终点是比较LEMI和HEMI患者的BCVI率。
结果：八百六十例患者（78%）进行了BCVI筛查；120例BCVI阳性。LEMI组和HEMI组的BCVI发生率相似(12.6%对14.4%;P=0.640)。与HEMI患者（n=95）相比，LEMI患者（n=25）明显年龄较大（79±14.9对54.3±17.4，P<0.001），入院前服用抗凝剂的可能性更大(64%对23.2%，P<0.001)，和较不严重的损伤（LEMI损伤严重程度评分10.9±6.6与HEMI损伤严重程度评分18.7±11.4，P=0.001）。除一名LEMI和90.5％的HEMI患者外，所有患者均有椎动脉损伤，BCVI等级无显着差异。一名HEMI患者由于BCVI筛查而出现急性肾损伤。11例HEMI患者发生BCVI相关卒中，有2例相关死亡率。一名LEMI患者死于BCVI相关卒中。
结论：根据颈椎骨折进行筛查时，HEMI和LEMI组的BCVI发生率相似。LEMI组无筛查或治疗并发症，提示治疗带来的益处可能大于筛查和潜在出血并发症的风险.
