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. 2018 Jul 4:13:30.
doi: 10.1186/s13017-018-0188-z. eCollection 2018.

Blunt cerebrovascular injury in elderly fall patients: are we screening enough?

Vincent P Anto  1 , Joshua B Brown  1 , Andrew B Peitzman  1 , Brian S Zuckerbraun  1 , Matthew D Neal  1 , Gregory Watson  1 , Raquel Forsythe  1 , Timothy R Billiar  1 , Jason L Sperry  1
Affiliations

Blunt cerebrovascular injury in elderly fall patients: are we screening enough?

Vincent P Anto et al. World J Emerg Surg. .

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.

Keywords: Blunt cerebrovascular injury; Elderly; Falls; Incidence; Intravenous contrast; Screening.

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Conflict of interest statement

This research was approved by the University of Pittsburgh institutional review board. IRB PRO15020269.No direct individual data is included in this manuscript. This was a retrospective study and not a registered trial.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Screening rates for BCVI with known upper cervical spine fracture. *p < 0.05 relative to 18–64-year-old group; †p < 0.05 relative to elderly non-GLF group
See this image and copyright information in PMC

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