Risk Factors and Clinical Outcomes Among Adult Patients with Isolated Blunt Cerebrovascular Injuries: A National Analysis

Document Type

Article

Publication Date

11-5-2025

Publication Title

Journal of Trauma Nursing

Abstract

BACKGROUND: Blunt cerebrovascular injury (BCVI) is a rare but serious trauma complication linked to high stroke risk and mortality, often presenting without symptoms and delaying diagnosis. Despite known risk factors, data remain limited on outcomes, especially in patients with concurrent traumatic brain injury (TBI). Additionally, optimal management strategies, particularly for high-grade injuries, remain unclear. OBJECTIVE: The purpose of this study is to evaluate the incidence of BCVI, the associated risk factors, and outcomes for patients with BCVI with or without TBI to improve overall prognosis and outcomes in this patient population. METHODS: This retrospective cohort analysis utilized the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database (2017-2021). The study population included adult (age ≥ 16 years) blunt trauma patients with Injury Severity Score (ISS) of ≥ 9 and severe isolated (Abbreviated Injury Scale [AIS] head and neck ≥ 3, all other regions < 3) BCVI. Patients were then stratified based on the presence or absence of concomitant mild-moderate TBI (AIS head ≤ 2). Clinical outcomes were compared between BCVI and non-BCVI patients, including incidence of ischemic stroke, mortality rate, intensive care unit length of stay, ventilator-free days, and BCVI risk factors such as cervical spine fracture, mandibular fracture, basilar skull fracture, and presenting Glasgow Coma Scale (GCS) ≤ 8. RESULTS: Of 2,172 patients with isolated BCVI, 1,262 (58.1%) had carotid artery injuries and 910 (41.9%) had vertebral artery injuries. Among non-TBI patients, BCVI was significantly associated with cervical spine fractures (OR: 11.60, p < .001), mandibular fractures (OR: 2.87, p < .001), GCS ≤ 8 (OR: 1.65, p = .001), and ischemic stroke (OR: 19.32, p < .001). Among TBI patients, BCVI was significantly associated with cervical spine fractures (OR: 6.79, p < .001), mandibular fractures (OR: 2.10, p < .001), and ischemic stroke (OR: 40.67, p < .001). CONCLUSIONS: Patients with BCVI had significantly higher odds of presenting with cervical spine and mandibular fractures in addition to ischemic stroke compared to those without BCVI. Understanding the risk factors for BCVI can help guide further investigations and support prompt diagnosis, optimizing care, and improving patient outcomes.

First Page

358

Last Page

367

PubMed ID

41092081

Rights

© 2025 Society of Trauma Nurses

Link to Full Text

Share

COinS