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Venous Sinus Thrombosis in Blunt Trauma: Incidence and Risk Factors

Slasky, Shira E. MD*; Rivaud, Yayone MD*; Suberlak, Matthew MD*; Tairu, Oluwole MD*; Fox, Adam D. MD; Ohman-Strickland, Pamela PhD; Bilinisky, Esther MD, MS*

Journal of Computer Assisted Tomography: November/December 2017 - Volume 41 - Issue 6 - p 891–897
doi: 10.1097/RCT.0000000000000620
Neuroradiology

Purpose The aim of our study was to determine the incidence and risk factors of dural venous sinus thrombosis and epidural hemorrhage in the setting of a blunt trauma causing a calvarial fracture crossing a dural venous sinus.

Methods A retrospective review of 472 blunt trauma patients with calvarial fracture crossing a dural venous sinus was performed. Two hundred ten patients who underwent computed tomography venography were identified and evaluated for the presence of dural venous sinus thrombosis and/or epidural hemorrhage. Site and displacement of fractures, as well as age, sex, Glasgow Coma Scale (GCS) score, and mechanism of injury, were considered for potential predictive value of thrombosis and/or epidural hemorrhage.

Results We found a 23% incidence of dural venous sinus thrombosis in patients with a fracture traversing a dural venous sinus. Significant predictors of thrombosis included temporal fracture (38% incidence) and skull base fracture (31% incidence). Occipital fracture not involving the skull base was associated with a significantly decreased risk of thrombosis, with an incidence of 9%. Decreased GCS score and fall from height greater than 10 feet additionally predicted dural venous sinus thrombosis. Significant predictors of epidural hemorrhage included parietal fractures and displaced fractures, although a large percentage of nondisplaced fractures in other bones demonstrated epidural hemorrhage as well.

Conclusions Dural venous sinus thrombosis in the setting of blunt trauma with a calvarial fracture crossing a dural venous sinus has an incidence of 23%. Increased suspicion for thrombosis is warranted in patients with temporal or skull base fractures, low GCS score, and recent fall from great height.

From the Departments of *Radiology and †Trauma Surgery, New Jersey School of Medicine, Rutgers, The State University of New Jersey, Newark; and ‡Rutgers School of Public Health, RWJ–School of Public Health, Piscataway, NJ.

Received for publication November 15, 2016; accepted February 1, 2017.

Correspondence to: Shira E. Slasky, MD, Department of Radiology, New Jersey School of Medicine, Rutgers, The State University of New Jersey, 150 Bergen St, UH Suite C-318 A, Newark, NJ 07103 (e-mail: sslasky@gmail.com).

Institutional review board approval was obtained for this study.

S.I.S. received a New Jersey Medical School Radiology departmental research grant to pay for statistical analysis for this study. The other authors declare no conflict of interest.

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