Venous sinus thrombosis in blunt trauma: Incidence and risk factors

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.