{"title":"颈椎钝挫伤后的椎动脉损伤是偶然发现吗？","authors":"Romil Shah, Ayane Rossano, Devender Singh, Eeric Truumees","doi":"10.1097/BSD.0000000000001747","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To understand the associations between vertebral artery injury (VAI) and adverse events in patients sustaining blunt cervical spine trauma.</p><p><strong>Summary of background data: </strong>To date, the impact of VAI on adverse events, and by extension, clinical outcomes has been extracted from small patient cohorts and have not allowed definitive conclusions.</p><p><strong>Methods: </strong>Adult patients with cervical vertebral, ligamentous, or neurological trauma in the National Trauma Data Bank from 2016 to 2017 were included in the study. Demographic information (age, sex, and race), injury-specific information (mechanism, severity), patient health information, and presence of a VAI were collected as explanatory variables. Response variables included development of adverse events [DVT/PE, myocardial infarction (MI), stroke, hemorrhage, or neurological deficit] length of stay (LOS) and unplanned ICU admission or surgical procedure. Multivariable regression was used to calculate the risk-adjusted effect of vertebral artery injury on the presence of adverse and unplanned events as well as its relationship with LOS.</p><p><strong>Results: </strong>Totally, 128,908 patients with cervical trauma were reviewed, of which 5300 had VAI. Of the patients with VAI, 187 (3.5%) patients had a MI, 156 (2.9%) had a PE/DVT, 196 (3.7%) had a stroke, 1392 (26.3%) had neurological injury, and 443 (8.4%) had an unplanned operative procedure or ICU admission. After risk-adjustment, VAI was associated with a >2-fold increased risk of increased LOS and ICU LOS (P<0.001), as well as greater than a 2-fold increased risk of MI, PE/DVT, stroke, and neurological injury (P<0.001).</p><p><strong>Conclusions: </strong>Our study documented a higher rate of concomitant VAI in blunt cervical trauma than previously reported. VAI is a hallmark of a more severe or higher energy mechanism of injury and is associated with increased adverse events and LOS in the hospital/ICU. In addition, these data suggest that, in older patients, concomitant VAI is associated with adverse outcomes independent of mechanism of injury.</p><p><strong>Level of evidence: </strong>Step II-diagnostic study.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Is Vertebral Artery Injury After Blunt Cervical Spine Trauma an Incidental Finding?\",\"authors\":\"Romil Shah, Ayane Rossano, Devender Singh, Eeric Truumees\",\"doi\":\"10.1097/BSD.0000000000001747\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>To understand the associations between vertebral artery injury (VAI) and adverse events in patients sustaining blunt cervical spine trauma.</p><p><strong>Summary of background data: </strong>To date, the impact of VAI on adverse events, and by extension, clinical outcomes has been extracted from small patient cohorts and have not allowed definitive conclusions.</p><p><strong>Methods: </strong>Adult patients with cervical vertebral, ligamentous, or neurological trauma in the National Trauma Data Bank from 2016 to 2017 were included in the study. Demographic information (age, sex, and race), injury-specific information (mechanism, severity), patient health information, and presence of a VAI were collected as explanatory variables. Response variables included development of adverse events [DVT/PE, myocardial infarction (MI), stroke, hemorrhage, or neurological deficit] length of stay (LOS) and unplanned ICU admission or surgical procedure. Multivariable regression was used to calculate the risk-adjusted effect of vertebral artery injury on the presence of adverse and unplanned events as well as its relationship with LOS.</p><p><strong>Results: </strong>Totally, 128,908 patients with cervical trauma were reviewed, of which 5300 had VAI. Of the patients with VAI, 187 (3.5%) patients had a MI, 156 (2.9%) had a PE/DVT, 196 (3.7%) had a stroke, 1392 (26.3%) had neurological injury, and 443 (8.4%) had an unplanned operative procedure or ICU admission. After risk-adjustment, VAI was associated with a >2-fold increased risk of increased LOS and ICU LOS (P<0.001), as well as greater than a 2-fold increased risk of MI, PE/DVT, stroke, and neurological injury (P<0.001).</p><p><strong>Conclusions: </strong>Our study documented a higher rate of concomitant VAI in blunt cervical trauma than previously reported. VAI is a hallmark of a more severe or higher energy mechanism of injury and is associated with increased adverse events and LOS in the hospital/ICU. In addition, these data suggest that, in older patients, concomitant VAI is associated with adverse outcomes independent of mechanism of injury.</p><p><strong>Level of evidence: </strong>Step II-diagnostic study.</p>\",\"PeriodicalId\":10457,\"journal\":{\"name\":\"Clinical Spine Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-11-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Spine Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BSD.0000000000001747\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Spine Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BSD.0000000000001747","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
研究设计回顾性队列研究：了解颈椎钝挫伤患者椎动脉损伤（VAI）与不良事件之间的关联：迄今为止，VAI 对不良事件的影响以及对临床结果的影响都是从小型患者队列中提取的，因此无法得出明确的结论：研究纳入了2016年至2017年国家创伤数据库中的颈椎、韧带或神经创伤成人患者。作为解释变量，收集了人口统计学信息（年龄、性别和种族）、特定损伤信息（机制、严重程度）、患者健康信息以及是否存在 VAI。反应变量包括不良事件的发生（深静脉血栓/脑栓塞、心肌梗塞（MI）、中风、出血或神经功能缺损）、住院时间（LOS）和非计划性入住重症监护室或外科手术。采用多变量回归法计算椎动脉损伤对不良事件和非计划事件发生的风险调整效应及其与住院时间的关系：共对 128,908 名颈椎创伤患者进行了复查，其中 5300 名患者有 VAI。在发生 VAI 的患者中，187 人（3.5%）发生了心肌梗死，156 人（2.9%）发生了 PE/DVT，196 人（3.7%）发生了中风，1392 人（26.3%）发生了神经损伤，443 人（8.4%）发生了计划外手术或入住重症监护室。经过风险调整后，VAI 与 LOS 和 ICU LOS 增加的风险增加 2 倍以上有关（结论：我们的研究记录了较高的并发症发生率：我们的研究表明，在钝性颈椎创伤中并发 VAI 的比例高于之前的报道。VAI 是更严重或更高能量的损伤机制的标志，与不良事件和住院/重症监护室时间的延长有关。此外，这些数据还表明，在老年患者中，与损伤机制无关的并发VAI与不良后果有关：第二步诊断性研究。
Is Vertebral Artery Injury After Blunt Cervical Spine Trauma an Incidental Finding?
Study design: Retrospective cohort study.
Objectives: To understand the associations between vertebral artery injury (VAI) and adverse events in patients sustaining blunt cervical spine trauma.
Summary of background data: To date, the impact of VAI on adverse events, and by extension, clinical outcomes has been extracted from small patient cohorts and have not allowed definitive conclusions.
Methods: Adult patients with cervical vertebral, ligamentous, or neurological trauma in the National Trauma Data Bank from 2016 to 2017 were included in the study. Demographic information (age, sex, and race), injury-specific information (mechanism, severity), patient health information, and presence of a VAI were collected as explanatory variables. Response variables included development of adverse events [DVT/PE, myocardial infarction (MI), stroke, hemorrhage, or neurological deficit] length of stay (LOS) and unplanned ICU admission or surgical procedure. Multivariable regression was used to calculate the risk-adjusted effect of vertebral artery injury on the presence of adverse and unplanned events as well as its relationship with LOS.
Results: Totally, 128,908 patients with cervical trauma were reviewed, of which 5300 had VAI. Of the patients with VAI, 187 (3.5%) patients had a MI, 156 (2.9%) had a PE/DVT, 196 (3.7%) had a stroke, 1392 (26.3%) had neurological injury, and 443 (8.4%) had an unplanned operative procedure or ICU admission. After risk-adjustment, VAI was associated with a >2-fold increased risk of increased LOS and ICU LOS (P<0.001), as well as greater than a 2-fold increased risk of MI, PE/DVT, stroke, and neurological injury (P<0.001).
Conclusions: Our study documented a higher rate of concomitant VAI in blunt cervical trauma than previously reported. VAI is a hallmark of a more severe or higher energy mechanism of injury and is associated with increased adverse events and LOS in the hospital/ICU. In addition, these data suggest that, in older patients, concomitant VAI is associated with adverse outcomes independent of mechanism of injury.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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