Traumatic Brain Injury Identifies a High-Risk Phenotype in Blunt Cerebrovascular Injury

Authors

• Frank H. Lau, Keliomics Inc., Portland, OR
• Genevieve E. Messa, LSU Health Sciences Center – New OrleansFollow
• Mark A. Maier, LSU Health Sciences Center – New OrleansFollow
• Tanja Milosavljevic, LSU Health Sciences Center – New OrleansFollow
• Ramcharan Thiagarajan, LSU Health Sciences Center – New OrleansFollow
• James C. Watson, LSU Health Sciences Center – New OrleansFollow
• Elyse R. Bevier-Rawls, LSU Health Sciences Center – New OrleansFollow
• Jonathan Babin, Ochsner Clinic Foundation, New Orleans, LA
• Nathan Bolton, Ochsner Clinic Foundation, New Orleans, LA
• Alison A. Smith, LSU Health Sciences Center – New OrleansFollow
• J Phillip Boudreaux, LSU Health Sciences Center – New OrleansFollow
• Patrick P. Greiffenstein, LSU Health Sciences Center – New OrleansFollow
• John E. Morrison, LSU Health Sciences Center – New OrleansFollow
• Guy R. Orangio, LSU Health Sciences Center – New OrleansFollow
• John P. Hunt, LSU Health Sciences Center – New OrleansFollow
• Kurt G. Davis, LSU Health Sciences Center – New Orleans
• Alan B. Marr, LSU Health Sciences Center – New OrleansFollow
• Lance E. Stuke, LSU Health Sciences Center – New OrleansFollow
• Mary A. Maluccio, LSU Health Sciences Center – New OrleansFollow
• George Fuhrman, Ochsner Clinic Foundation, New Orleans, LA
• Jeffanne Millien, Ochsner Clinic Foundation, New Orleans, LA
• Jonathan E. Schoen, LSU Health Sciences Center – New OrleansFollow
• Aaron Klinger, LSU Health Sciences Center – New Orleans
• Jeffrey S. Barton, LSU Health Sciences Center – New Orleans
• Denise Danos, LSU Health Sciences Center – New OrleansFollow
• Michael W. Cook, LSU Health Sciences Center – New OrleansFollow
• Ian A. Hodgdon, LSU Health Sciences Center – New OrleansFollow

Document Type

Article

Publication Date

7-24-2026

Publication Title

The American Surgeon

Abstract

IntroductionBlunt cerebrovascular injury (BCVI) inherently carries high morbidity and mortality, while the effect of concomitant traumatic brain injury (TBI) on survival in BCVI patients is unclear. We examined mortality risk in BCVI patients comparing those with and without TBI.MethodsAdult BCVI patients diagnosed via CT angiography were identified from a multicenter database (52 trauma centers from May 2024 to August 2025). Traumatic brain injury was defined as the presence of acute intracranial injury on initial head CT. Blunt cerebrovascular in jury severity was categorized with Biffl grades 1-2 as the reference.ResultsOf 13,235 screened patients, 1,833 (13.8%) were diagnosed with BCVI; after excluding missing data, 1,674 patients were included in the analysis. Traumatic brain injury patients (n=736, 44%) were significantly younger (44 vs 50; P < 0.0001) with higher ISS (median 26 vs 17; P < 0.0001). Traumatic brain injury patients experienced stroke more frequently (7.5% vs 3.3%; P = 0.0001). In-hospital mortality (n = 236, 14.2%) occurred more frequently among TBI patients (24.1% vs 6.4%; P < 0.0001). In a multivariable analysis, TBI (OR 1.63, 95% CI: 1.08-2.46; P = 0.02) and stroke (OR 1.82, 95% CI: 1.01-3.27; P = 0.046) significantly increased in-hospital mortality risk, whereas higher GCS on arrival was protective (OR 0.79 per point, 95% CI: 0.76-0.82; P < 0.0001).ConclusionThese findings suggest that patients with concomitant BCVI and TBI represent a high-risk subgroup characterized by greater injury severity and more complex vascular involvement. The observed association between TBI and increased mortality supports closer multidisciplinary evaluation, surveillance, and consideration of tailored management strategies.

First Page

31348261471488

PubMed ID

42498705

Rights

© The Author(s) 2026

Recommended Citation

Lau, Frank H.; Messa, Genevieve E.; Maier, Mark A.; Milosavljevic, Tanja; Thiagarajan, Ramcharan; Watson, James C.; Bevier-Rawls, Elyse R.; Babin, Jonathan; Bolton, Nathan; Smith, Alison A.; Boudreaux, J Phillip; Greiffenstein, Patrick P.; Morrison, John E.; Orangio, Guy R.; Hunt, John P.; Davis, Kurt G.; Marr, Alan B.; Stuke, Lance E.; Maluccio, Mary A.; Fuhrman, George; Millien, Jeffanne; Schoen, Jonathan E.; Klinger, Aaron; Barton, Jeffrey S.; Danos, Denise; Cook, Michael W.; and Hodgdon, Ian A., "Traumatic Brain Injury Identifies a High-Risk Phenotype in Blunt Cerebrovascular Injury" (2026). School of Medicine Faculty Publications. 5017.
https://digitalscholar.lsuhsc.edu/som_facpubs/5017
10.1177/00031348261471488