A Prospective Cohort Study Characterizing Incidence of Dural Venous Sinus Thrombosis in Traumatic Brain Injury Patients with Skull Fractures

Abstract

BackgroundLimited retrospective data suggest that dural venous sinus thrombosis (DVST) in traumatic brain injury (TBI) patients with skull fractures is common and associated with significant morbidity and mortality. Prospective data accurately characterising the incidence of DVST in high-risk TBI patients are sparse but are needed to develop evidence-based TBI management guidelines. MethodsAfter obtaining institutional clinical safety and quality unit approval, 36 adult TBI patients with skull fractures admitted to an Australian level III adult intensive care unit (ICU) between April 2022 and January 2023 were prospectively recruited and underwent CT venogram (CTV) or Magnetic resonance venogram (MRV) within 72 hours of injury. When available, daily maximum intracranial pressure (ICP) were recorded. ResultsDVS abnormality was common (36.1%, 95% confidence interval [CI] 22.5-52.4%) and strongly associated with DVST (p=0.003). The incidence of DVST was 13.9% (95%CI 6.1-28.7%) which was lower than those reported in previous retrospective studies. Eighty percent of the DVST confirmed by a CTV occurred in those with extensive skull fractures including temporal or parietal bone fractures in conjunction with occipital bone fractures (p=0.006). DVS abnormality and DVST were, however, not associated with an increased in maximum daily ICP within the first 7 days after injury. ConclusionsDVS abnormality was common in TBI patients with skull fractures requiring ICU admission. DVST was confirmed in more than a third of these patients, especially among those with concomitant temporal or parietal and occipital bone fractures. CTV would be advisable for this subgroup of TBI patients.