Traumatic Brain Injury Identifies a High-Risk Phenotype in Blunt Cerebrovascular Injury

Introduction Blunt cerebrovascular injury (BCVI) inherently carries high morbidity and mortality, while the effect of concomitant traumatic brain injury (TBI) on survival in BCVI patients is unclear. We examined mortality risk in BCVI patients comparing those with and without TBI. Methods Adult BCVI patients diagnosed via CT angiography were identified from a multicenter database (52 trauma centers from May 2024 to August 2025). Traumatic brain injury was defined as the presence of acute intracranial injury on initial head CT. Blunt cerebrovascular in jury severity was categorized with Biffl grades 1-2 as the reference. Results Of 13,235 screened patients, 1,833 (13.8%) were diagnosed with BCVI; after excluding missing data, 1,674 patients were included in the analysis. Traumatic brain injury patients (n=736, 44%) were significantly younger (44 vs 50; P < 0.0001) with higher ISS (median 26 vs 17; P < 0.0001). Traumatic brain injury patients experienced stroke more frequently (7.5% vs 3.3%; P = 0.0001). In-hospital mortality (n = 236, 14.2%) occurred more frequently among TBI patients (24.1% vs 6.4%; P < 0.0001). In a multivariable analysis, TBI (OR 1.63, 95% CI: 1.08-2.46; P = 0.02) and stroke (OR 1.82, 95% CI: 1.01-3.27; P = 0.046) significantly increased in-hospital mortality risk, whereas higher GCS on arrival was protective (OR 0.79 per point, 95% CI: 0.76-0.82; P < 0.0001). Conclusion These findings suggest that patients with concomitant BCVI and TBI represent a high-risk subgroup characterized by greater injury severity and more complex vascular involvement. The observed association between TBI and increased mortality supports closer multidisciplinary evaluation, surveillance, and consideration of tailored management strategies.