Abstract Details

Title Incidence and Outcome of Vertebral Artery Dissection in Trauma Setting: Analysis from National Trauma Data Base (NTDB)

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P01 - (-)

Poster/Presentation
Number 029

Objective

Background Vertebral artery dissection(VAD) is an important cause of stroke in young adults. The natural history and epidemiological aspects of traumatic VAD are not fully understood.

Design/Methods All patients who were admitted with traumatic brain injury or head and neck injury were identified by ICD-9-CM codes from the National Trauma Data Bank(NTDB). NTDB represents one of the largest trauma databases and contains data from over 900 trauma centers across the United States. Presence of VAD was identified in these patients by using ICD-9-CM codes. Admission GCS, Injury Severity Score(ISS), in-hospital complications and treatment outcomes were compared between patients with VAD to patients without vascular dissection.

Results A total of 84 VAD patients were identified which comprised 0.1% of all patients admitted with head and neck injury. The mean age for patients with VAD was significantly higher than patients without dissection[46 (95% CI: 41-50) versus 41.3 (95% CI: 41.2-41.4); p= 0.003]. The admission GCS score was significantly lower in patients with VAD with 31% of these patients presenting with GCS<9 (p=<.0001). Patients with VAD had higher rate of in-hospital stroke than the patients without dissection(5% versus 0.2%; p=<.0001). Numbers of ICU days, ventilator days, and hospital length of stays were all significantly higher in patients with VAD. These differences remained significant after adjusting for the demographics, admission GCS and ISS(p=<.0001). Only 8% of the patients with VAD received endovascular treatment and there was no in-hospital stroke in these patients.

Conclusions Although infrequent, vertebral artery dissection in head and neck trauma is associated with higher rates of in-hospital stroke and greater length of ICU and hospital stay. Considering the risks associated with anticoagulation in trauma setting, endovascular treatment may be an alternate option to reduce in-hospital complications in these patients.

Authors/Disclosures
Vikram Jadhav, MD (Minnesota Stroke Network) PRESENTER	No disclosure on file
Shahram Majidi, MD (Icahn School of Medicine at Mount Sinai)	Dr. Majidi has nothing to disclose.
	No disclosure on file
	No disclosure on file
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.
Tanuja Chitnis, MD, FAAN (Brigham and Women's Hospital)	Dr. Chitnis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Chitnis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche-Genentech. Dr. Chitnis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Octave Biosciences. Dr. Chitnis has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. The institution of Dr. Chitnis has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Chitnis has received research support from Novartis. The institution of Dr. Chitnis has received research support from Sanofi. The institution of Dr. Chitnis has received research support from Octave. The institution of Dr. Chitnis has received research support from Genentech-Roche. The institution of Dr. Chitnis has received research support from Tiziana Life Sciences. The institution of Dr. Chitnis has received research support from Bristol-Myers Squibb. The institution of Dr. Chitnis has received research support from Wesley Clover.

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