Clinical characteristics, management, and outcomes of traumatic cerebral venous sinus thrombosis
Bibliographic record
Abstract
BACKGROUND: Traumatic cerebral venous sinus thrombosis (CVST) is abnormal clotting in one or more cerebral veins or sinuses following trauma. Its clinical significance is uncertain. Management is challenging because patients are at increased risk for bleeding. Limited studies exist on traumatic CVST. METHODS: Retrospective cohort study of trauma patients admitted to a Level 1 trauma center between January 2014 and October 2023. Main objectives were to assess the following: (1) CVST prevalence, overall and according to head injury severity; (2) characteristics of trauma patients with CVST; and (3) management and outcomes of CVST patients. RESULTS: On admission, all CVST patients (n = 170) had a traumatic brain injury (TBI) and an intracranial hemorrhage, and all except one had a skull fracture. Prevalence of CVST was 0.9% (95% confidence interval [CI], 0.8-1.0) in the overall trauma patient population (n = 18,569), 2.1% (95% CI, 1.9-2.5) in patients with TBI (n = 7,920), and 4.8% (95% CI, 4.0-5.8) in patients with severe TBI (modified head Abbreviated Injury Scale score, ≥4; n = 2,035). Twenty-eight patients with CVST died (16.5%), usually shortly after admission. The majority of patients (n = 100) with CVST were treated with standard venous thromboembolism (VTE) prophylactic dose of anticoagulant while in hospital. During median follow-up of 3 months, none of the patients treated with standard VTE prophylactic dose of anticoagulant developed a symptomatic CVST-related adverse event (death, stroke, intracranial hemorrhage). One patient (1.0%) had asymptomatic CVST-related stroke, three patients (3.0%) developed asymptomatic CVST extension, and 3 patients (3.0%) developed a gastrointestinal bleed on anticoagulant. CONCLUSION: Traumatic CVST prevalence increases with head trauma severity and is unlikely to develop in the absence of skull fracture. Patients treated with standard VTE prophylactic doses of anticoagulants had favorable outcomes with minimal CVST-related complications during hospitalization. Longer-term data are needed to better evaluate traumatic CVST prognosis. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".