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  • Arterial Dissection in Trauma Patients in the Absence of Traumatic Brain Injury and Cervical Spine Trauma: A Population-Based Study of the Detroit Metropolitan Area from 2006-2014

    Final Number:

    Justin G Thomas DO; Richard D. Fessler MD, FACS; R David Hayward PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Traumatic brain injury (TBI) and cervical spine injury (CSI) are associated with an increased risk of arterial dissection. The purpose of this study is to determine the occurrence of arterial dissection in trauma patients without TBI or CSI.

    Methods: Data was obtained from the Agency for Health Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP). Between 2006 and 2014, trauma patients were identified using ICD-9 codes 800 – 959 from the Michigan State Inpatient Database of patients living in the Detroit Metropolitan Statistical Area. Patient level data was merged with socioeconomic data from the US Census Bureau. Patients with TBI and CSI were excluded. Patients with dissection coincident with trauma were identified using specific ICD-9 codes (Table 1). Incidence of traumatic arterial dissection (non-CNS related) was determined. Subgroup analysis (age, gender, race, trauma mechanism, insurance type, and socioeconomic class) was performed to identify non-CNS trauma populations at risk for developing arterial dissection. Frequencies and confidence intervals were computed using SAS Proc SurveyFreq. Age-adjusted estimates were performed with logistical regression analysis.

    Results: A total of 406,245 trauma patients were identified and 23,822 excluded because of TBI or CSI, entailing an overall sample size of 383,423 individuals. Arterial dissection was identified in 12,812 patients with an overall incidence of 3.3%. The occurrence of dissection increased significantly with age, as adults 65+ years of age were over five times more likely to develop a dissection than younger adults. Logistic regression was performed to account for the significant relationship between older age and arterial dissection. Male gender, falls and gunshot wounds were significantly more likely to suffer arterial dissection, as were Medicare and Medicaid beneficiaries and those living in neighborhoods below the median poverty level.

    Conclusions: The current study provides insight into patients at increased risk for arterial dissection following non-primary CNS related trauma.

    Patient Care: Will offer medical providers knowledge and insight on how to anticipate potential arterial dissection and/or stroke in non-cranial or cervical spine trauma patients by identifying risk factors and patient subgroups.

    Learning Objectives: 1. Identify risk factors for cerebral arterial dissection after trauma 2. Recognize the age-related changes associated with arterial dissection after trauma 3. Understand the socioeconomic relationship between trauma and cerebrovascular dissections

    References: 1. Chen Y-H, Kang J-H, Lin H-C. Patients with traumatic brain injury: population-based study suggests increased risk of stroke. Stroke. 2011 Oct;42(10):2733–9.  2. Burke JF, Stulc JL, Skolarus LE, Sears ED, Zahuranec DB, Morgenstern LB. Traumatic brain injury may be an independent risk factor for stroke. Neurology. 2013 Jul 2;81(1):33–9.  3. Wojcik JB, Benns MV, Franklin GA, Harbrecht BG, Broughton-Miller KD, Frisbie MC, et al. Traumatic injury may be a predisposing factor for cerebrovascular accident. J Trauma Nurs. 2013 Sep;20(3):139-143-145.

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