Objective:

This study provides the largest-to-date epidemiologic analysis of blunt cerebrovascular injury (BCVI) in traumatic brain injury (TBI) with the goal of better elucidating mechanisms, risk factors, and outcomes. 

Background:

BCVI is a serious complication of moderate to severe TBI and is associated with negative outcomes including stroke. Published studies assessing incidence of BCVI have been limited by sample size due to requirement for protocolized vessel imaging during trauma alerts.  

Design/Methods:

All level 1 and 2 trauma alerts associated with TBI at University of Florida between 1/1/2019 and 12/31/2024 underwent CT angiography of either neck or both head and neck to screen for vascular injury. Patient data collected directly from electronic medical records with a standardized data entry instrument. Cases underwent simple randomization and analysis of first 357 cases is presented here with remainder forthcoming. 

Results:

A total of 14,255 traumas were screened of which 4,112 (28.8%) were associated with TBI. Of 357 randomly sampled TBI cases, 19.5% were found to have BCVI. There was a significant relationship between age group and BCVI incidence (LRT χ² (6) = 16.21, p = 0.013). Patients aged 18-24 had highest odds of BCVI, which was 6 times more likely than those 75+ (OR 6.0, 95% CI 2.2 - 19.7, p = 0.001). Among mechanisms, BCVI was significantly more common in high-energy (e.g. motor vehicle) compared to low-energy traumas (χ² (1) = 25.27, p < 0.001). High-energy traumas resulted in 10-fold higher odds of sustaining BCVI (OR = 10.2, 95% CI 4.0-34.5). 

Conclusions:

Findings from this study suggest BCVI incidence at 19.5% is significantly higher than previously thought. BCVI is more common in young individuals and high energy traumas, including motor vehicle collisions. These are preliminary findings from a large TBI patient database and future analyses will further clarify BCVI characteristics, complications, and outcomes.