Risk factors and outcomes associated with blunt cerebrovascular injury in patients with mild or moderate traumatic brain injury

Abstract Objective Blunt cerebrovascular injury (BCVI) represents a spectrum of traumatic injuries to the carotid and vertebral arteries that is an often-overlooked source of morbidity and mortality. Its incidence, risk factors, and effect on outcomes in patients with mild or moderate traumatic brain injury (mTBI) have not been studied independently. Methods The National Trauma Data Bank from 2013 to 2017 was queried to identify patients with mTBI who suffered blunt injuries. BCVI was identified using Abbreviated Injury Scores and included blunt carotid artery injury (BCAI) and blunt vertebral artery injury (BVAI). A binary logistic regression was used to identify patient- and injury-related factors associated with BCVI. Binary logistic regressions were also performed to evaluate the effect of BCVI on stroke, in-hospital mortality, non-routine discharge disposition, total length of stay (LOS), intensive care unit (ICU) LOS, and number of days mechanically ventilated. Results Out of 485,880 patients with mTBI there were 4,382 (0.9%) with BCVI. Cervical spine fracture was the strongest factor associated with BCAI (OR 1.97, 95% CI 1.77 – 2.19), followed by mandible fracture and basilar skull fracture. Cervical spine fracture also had the strongest association with BVAI (OR 18.28, 95% CI 16.47 – 20.28), followed by spinal cord injury and neck contusion. Stroke was more common in patients with BCAI (OR 5.50, 95% CI 4.19 – 7.21) and BVAI (OR 7.238, 95% CI 5.929 – 8.836). BVAI increased the odds of mortality but BCAI did not. Both were associated with non-routine discharge and increased LOS, ICU LOS, and number of days mechanically ventilated. Conclusions The incidence of BCVI in patients with mTBI is low, and it usually does not require invasive treatment. However, it is associated with greater odds of stroke and negative outcomes. Knowledge of risk factors for BCVI may tailor further investigation to aid prompt diagnosis.