Concomitant cranio-spinal trauma: additional risk from a cerebrovascular injury

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LETTER TO THE EDITOR - BRAIN TRAUMA

Concomitant cranio-spinal trauma: additional risk from a cerebrovascular injury Andreas K. Demetriades 1

&

Hege Linnerud 2 & Paul Gerdhem 3 & Wilco C. Peul 4

Received: 26 June 2020 / Accepted: 4 September 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020

Dear Editor, The retrospective study from the Helsinki Trauma Registry by Vehvilainen et al. shares important lessons in the field of concomitant cranio-spinal injury; 10% (26/255) of those with severe head injury had an associated cervical spine injury, and interestingly, such concomitant cervical spinal injury did not affect patient outcomes or 6-month mortality [4]. Instead, in those with severe head injury, they identified that additional risk with poor prognosis comes from concurrent blunt cerebrovascular injury (BCVI). This occurred at 8% cases (16/194), and such concomitant BCVI was associated with an unfavourable outcome; 6-fold increased odds for poor functional outcome and 8-fold increased odds for 6-month mortality. This builds on previous work where the presence of concomitant craniospinal injury, perhaps due to different demographics, was twice as high, but where CT angiography was not part of the acute trauma imaging protocol [3]. Synthesised epidemiological evidence has shown that—in patients with a traumatic brain injury—the prevalence of concomitant (any) This article is part of the Topical Collection on Brain trauma * Andreas K. Demetriades [email protected] 1

Department of Neurosurgery, Royal Infirmary Edinburgh, Edinburgh, Scotland, UK

2

Neurosurgical Department, Oslo University Hospital, Oslo, Norway

3

Department of Orthopaedics, Karolinska University Hospital and CLINTEC, Karolinska Institutet, K54, Karolinska University Hospital, Huddinge, SE 14186 Stockholm, Sweden

4

Department of Neurosurgery, University Neurosurgical Center Holland, LUMC Leiden, HMC & Haga Teaching Hospital, The Hague, The Netherlands

spinal injury was 12.5%, whereas that of cervical spinal injury was 6.5% [2]. After reading the paper, we would like to ask the authors for some additional clarifications. 1. Did cerebrovascular injury occur in the absence of spinal injury? 2. In cases with traumatic brain injury, how often is a concomitant cervical spine injury with and without a cerebrovascular injury? 3. Are outcomes in these groups different than in those with traumatic brain injury plus cervical spine injury plus BCVI? It would have been interesting to gain information on whether associated spinal cord injury (in addition to vertebral column injury) in this patient group would affect outcome, but likely the sample size is too small for meaningful comparisons. Also of interest is the authors’ local trauma imaging protocol, which includes a liberal CT angiography of the cervical spine, as a screening tool for BCVI. In our affiliated institutions, five out of six do not routinely include this in acute trauma imaging. Whether this is justified by the numbers described is unclear, and ongoing debate