Blunt cerebrovascular injury in elderly fall patients: are we screening enough?
Abstract Background 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 comp...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-07-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13017-018-0188-z |
| _version_ | 1828764882620645376 |
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| author | Vincent P. Anto Joshua B. Brown Andrew B. Peitzman Brian S. Zuckerbraun Matthew D. Neal Gregory Watson Raquel Forsythe Timothy R. Billiar Jason L. Sperry |
| author_facet | Vincent P. Anto Joshua B. Brown Andrew B. Peitzman Brian S. Zuckerbraun Matthew D. Neal Gregory Watson Raquel Forsythe Timothy R. Billiar Jason L. Sperry |
| author_sort | Vincent P. Anto |
| collection | DOAJ |
| description | Abstract Background 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). We hypothesized that BCVI in EGLF patients would be clinically significant and screening would be less common. Methods A 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. Results The 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. Conclusions The 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 registration IRB approval number: PRO15020269. Retrospective trial not registered |
| first_indexed | 2024-12-11T06:38:58Z |
| format | Article |
| id | doaj.art-b1fc26eda94a4697bc39ed18df8496f9 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-12-11T06:38:58Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-b1fc26eda94a4697bc39ed18df8496f92022-12-22T01:17:17ZengBMCWorld Journal of Emergency Surgery1749-79222018-07-011311810.1186/s13017-018-0188-zBlunt cerebrovascular injury in elderly fall patients: are we screening enough?Vincent P. Anto0Joshua B. Brown1Andrew B. Peitzman2Brian S. Zuckerbraun3Matthew D. Neal4Gregory Watson5Raquel Forsythe6Timothy R. Billiar7Jason L. Sperry8Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical CenterDivision of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical CenterDivision of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical CenterDivision of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical CenterDivision of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical CenterDivision of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical CenterDivision of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical CenterDivision of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical CenterDivision of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical CenterAbstract Background 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). We hypothesized that BCVI in EGLF patients would be clinically significant and screening would be less common. Methods A 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. Results The 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. Conclusions The 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 registration IRB approval number: PRO15020269. Retrospective trial not registeredhttp://link.springer.com/article/10.1186/s13017-018-0188-zBlunt cerebrovascular injuryElderlyFallsScreeningIncidenceIntravenous contrast |
| spellingShingle | Vincent P. Anto Joshua B. Brown Andrew B. Peitzman Brian S. Zuckerbraun Matthew D. Neal Gregory Watson Raquel Forsythe Timothy R. Billiar Jason L. Sperry Blunt cerebrovascular injury in elderly fall patients: are we screening enough? World Journal of Emergency Surgery Blunt cerebrovascular injury Elderly Falls Screening Incidence Intravenous contrast |
| title | Blunt cerebrovascular injury in elderly fall patients: are we screening enough? |
| title_full | Blunt cerebrovascular injury in elderly fall patients: are we screening enough? |
| title_fullStr | Blunt cerebrovascular injury in elderly fall patients: are we screening enough? |
| title_full_unstemmed | Blunt cerebrovascular injury in elderly fall patients: are we screening enough? |
| title_short | Blunt cerebrovascular injury in elderly fall patients: are we screening enough? |
| title_sort | blunt cerebrovascular injury in elderly fall patients are we screening enough |
| topic | Blunt cerebrovascular injury Elderly Falls Screening Incidence Intravenous contrast |
| url | http://link.springer.com/article/10.1186/s13017-018-0188-z |
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