Blunt cerebrovascular injuries and association with cervical spine injury.

Abstract

Introduction: Blunt cerebrovascular injuries (BCVI) associated with cervical spine injuries (CSI) carry a high risk of morbidity and mortality. This nationwide Danish study, covering the years 2017-2023, aimed to identify key BCVI predictors in patients with CSI to support improved early detection and management strategies.

Methods: The study analysed data from four level-1 trauma centres using the Abbreviated Injury Scale to classify BCVI cases. Factors assessed included age, sex, type of cervical injury and the Injury Severity Score (ISS).

Results: Age and sex were not significant predictors of BCVI (p = 0.12, p = 0.65). However, any form of CSI was a strong predictor (p less-than 0.001; odds ratios (OR) = 26.3; confidence intervals (95% CI): 16.84-41.12), as were cervical spine ligamentous injuries (p = 0.0007; OR = 5.4; 95% CI: 2.3-12.89). An increase in ISS score significantly correlated with BCVI risk (p = 0.001; OR = 1.03 per unit increase; 95% CI: 1.01-1.05). Specific cervical fractures were not independent predictors of BCVI.

Conclusions: From a Danish cohort of patients admitted to a level 1 trauma centre, we found a BCVI incidence of three per thousand. In case of verified injury to the cervical region, the incidence rose to 6.25%. Our findings underscore the need for increased vigilance and a standardised nationwide algorithm to prevent disability, loss of health-related quality of life, and mortality in CSI patients at risk of BCVI.

Funding: The study was funded by Offerfonden, Dagmar Marshall Fonden, and Torben and Alice Frimodt Fonden.

Trial registration: The data collection was approved by the local ethical committee and the Central Denmark Region Office for Research: 1-45-70-19-23.