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Venous Injury in Patients with Blunt Traumatic Brain Injury: Retrospective Analysis of a National Cohort

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Abstract

Background

Cerebral venous injury (CVI) includes injury to a dural venous sinus or major vein and leads to poorer outcomes for patients with blunt traumatic brain injury (TBI). We sought to identify the incidence, associated factors, and outcomes associated with CVI in a large national cohort.

Methods

Adult patients with blunt TBI were identified from the National Trauma Databank (2013–2017). Outcomes included inpatient mortality, discharge disposition, stroke, length of stay (LOS), intensive care unit LOS, and duration of mechanical ventilation. Multivariate regression models were used to identify the association between exposure variables and CVI, as well as each outcome.

Results

There were 619,659 patients with blunt TBI who met the inclusion criteria. CVI occurred in 1792 (0.3%) patients. Mixed intracranial injury type had the strongest association with CVI (odds ratio [OR] 2.89, 95% confidence interval [CI] 2.38–3.50), followed by isolated TBI (OR 1.76, 95% CI 1.54–2.02) and skull fracture (OR 1.72, 95% CI 1.55–1.91). CVI was associated with increased odds of mortality (OR 1.38, 95% CI 1.19–1.60), nonroutine discharge (OR 1.26, 95% CI 1.12–1.40), and stroke (OR 1.95, 95% CI 1.33–2.86). It was also associated with longer LOS (β 2.02, 95% CI 1.55–2.50) and intensive care unit LOS (β 0.14, 95% CI 0.13–0.16). Among locations of venous injury, superior sagittal sinus injury had significant associations with mortality (OR 2.93, 95% CI 1.62–5.30) and nonroutine discharge disposition (OR 1.94, 95% CI 1.12–3.35), whereas the others did not.

Conclusions

We identified a 0.3% incidence of CVI in all-comers with blunt TBI as well as several injury-related variables that may be used to guide investigation for dural venous sinus injury. CVI was associated with poorer outcomes, with superior sagittal sinus injury having the strongest association.

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Funding

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Authors and Affiliations

  1. Department of Neurosurgery, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA

    Haydn Hoffman & Lawrence S. Chin

  2. Department of Neurology, State University of New York Upstate Medical University, Syracuse, NY, USA

    Fadar O. Otite

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  1. Haydn Hoffman
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  2. Fadar O. Otite
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  3. Lawrence S. Chin
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Contributions

HH: conceptualization, formal analysis, and writing (original draft, review, and editing). FOO: conceptualization, writing (review and editing), supervision, and project administration. LSC: writing (review and editing), supervision, and project administration. The final manuscript was approved by all authors.

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Correspondence to Haydn Hoffman.

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The authors have no personal or financial conflicts of interest to disclose.

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Institutional review board approval was not required for this study because it used an existing publicly available national database.

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Hoffman, H., Otite, F.O. & Chin, L.S. Venous Injury in Patients with Blunt Traumatic Brain Injury: Retrospective Analysis of a National Cohort. Neurocrit Care 36, 116–122 (2022). https://doi.org/10.1007/s12028-021-01265-6

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  • DOI: https://doi.org/10.1007/s12028-021-01265-6

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