Abstract
BackgroundBlunt cerebrovascular injuries (BCVI) are generally associated with high-energy injury mechanisms. Less is known regarding lower-energy injuries in elderly patients. We sought to determine the incidence of BCVI and characterize current BCVI screening practices and associated complications in elderly ground-level fall patients (EGLF, ≥ 65 years). We hypothesized that BCVI in EGLF patients would be clinically significant and screening would be less common.MethodsA retrospective study was performed utilizing the National Trauma Data Bank (NTDB, 2007–2014) and single institutional data. BCVI risk factors and diagnosis were determined by ICD-9 codes. Presenting patient characteristics and clinical course were obtained by chart review. The NTDB dataset was used to determine the incidence of BCVI, risk factors for BCVI, and outcomes in the EGLF cohort. Local chart review focused on screening rates and complications.ResultsThe incidence of BCVI in EGLF patients was 0.15% overall and 0.86% in those with at least one BCVI risk factor in the NTDB. Upper cervical spine fractures were the most common risk factor for BCVI in EGLF patients. In EGLF patients, the diagnosis of BCVI was an independent risk factor for mortality (OR1.8, 95% C.I. 1.5–2.1). The local institutional data (2007–2014) had a BCVI incidence of 0.37% (n = 6487) and 1.47% in those with at least one risk factor (n = 1429). EGLF patients with a risk factor for BCVI had a very low rate of screening (44%). Only 8% of EGLF patients not screened had documented contraindications. The incidence of renal injury was 9% irrespective of BCVI screening.ConclusionsThe incidence of BCVI is clinically significant in EGLF patients and an independent predictor of mortality. Screening is less common in EGLF patients despite few contraindications. This data suggests that using age and injury mechanism to omit BCVI screening in EGLF patients may exclude an at-risk population.Trial registrationIRB approval number: PRO15020269. Retrospective trial not registered
Highlights
Blunt cerebrovascular injuries (BCVI) are generally associated with high-energy injury mechanisms
Despite the overall lower incidence, Elderly ground-level fall (EGLF) injuries accounted for 33% of the cases of BCVI
The current analysis provides evidence for the decreased incidence of BCVI in elderly ground-level fall patients compared to patients with other injury mechanisms
Summary
Blunt cerebrovascular injuries (BCVI) are generally associated with high-energy injury mechanisms. Less is known regarding lower-energy injuries in elderly patients. We sought to determine the incidence of BCVI and characterize current BCVI screening practices and associated complications in elderly ground-level fall patients (EGLF, ≥ 65 years). Blunt cerebrovascular injury (BCVI) is an injury to the carotid or vertebral arteries which can result in devastating consequences. Detection of BCVI before the onset of symptoms allows for appropriate treatment and greatly reduces the risk of neurological sequelae [5]. There have been considerable research efforts made to determine the appropriate risk factors for BCVI that warrant screening. Current screening guidelines for BCVI are based in part on anatomic risk factors such as cervical spine injuries and basilar skull fractures [6,7,8]
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