Skip to content
DraconiticResearch
Search Sources API
203,234 studies31 sourcesUpdated 55 min ago
Peer-reviewedCC BY 4.0Frontiers in Neurology

Trans-sinus fracture as the gatekeeper: a two-step clinical strategy to guide venous imaging in mild-to-moderate traumatic brain injury

  • Jincheng Zhan1
  • Xiangrong Chen1
  • Bikun Liu1
  • Xiaofeng Zhou1
  • Dongze Xu1
  • Zongtao Wu1
  1. 1Department of Neurosurgery, Ankang Hospital of Traditional Chinese Medicine
Read full textPDFDOICite

Abstract

Background: Traumatic cerebral venous sinus thrombosis (tCVST) is an underrecognized complication of traumatic brain injury (TBI). Despite its potential for serious neurological sequelae, no consensus exists regarding indications for CT venography (CTV) or MR venography (MRV) in patients with mild-to-moderate TBI. Trans-sinus fracture has been identified as a risk factor for tCVST, yet its predictive value alone remains insufficient to guide clinical decision-making.

Objective: To propose a two-step clinical decision strategy for guiding venous imaging selection in mild-to-moderate TBI, using trans-sinus fracture as a gatekeeper followed by D-dimer and headache visual analog scale (VAS) score stratification.

Methods: This single-center retrospective cohort study included 528 patients with mild-to-moderate TBI (Glasgow Coma Scale score > 8) who underwent CTV, MRV, or digital subtraction angiography between January 2024 and January 2026. Firth penalized logistic regression was employed to identify tCVST predictors. A two-step strategy was derived: Step 1 screened for trans-sinus fracture; Step 2 applied D-dimer threshold ≥ 3.95 mg/L or headache VAS score ≥ 3 in trans-sinus fracture-positive patients.

Results: Traumatic cerebral venous sinus thrombosis was diagnosed in 41 patients (7.8%). Trans-sinus fracture was independently associated with tCVST (odds ratio 8.44, 95% confidence interval 4.38–16.39; P < 0.0001). As a standalone gatekeeper, trans-sinus fracture yielded sensitivity 58.5%, specificity 89.1%, negative predictive value 96.3%, and positive likelihood ratio 3.96. Among trans-sinus fracture-positive patients, the high-risk subgroup (D-dimer ≥ 3.95 mg/L or VAS ≥ 3) exhibited a tCVST rate of 31.2%, compared with 4.3% in the low-risk subgroup. The two-step strategy achieved a number needed to image of 3, avoiding 85% of unnecessary venous examinations compared with universal screening, and reduced the number needed to image from 13 (universal approach) to 3 (two-step approach).

Conclusions: This two-step strategy represents a simple, bedside-ready exploratory tool that may help optimize CTV/MRV selection in mild-to-moderate TBI by identifying a high-yield subgroup for targeted imaging. These findings are hypothesis-generating and require prospective external validation before clinical implementation.

Related

  1. Risk Factors for Poor Outcomes of Mild and Moderate Traumatic Brain Injury Patients in Tanzania: A Retrospective Cohort Study Using Latent Class Analysis
    Loren Barcenas, Cyrus Elahi, William Nkenguye +5
    Health science reportsPeer-reviewedCC BY-NC-NDFull textGeneral medicineEurope PMC
  2. Decompressive craniectomy in adults with moderate to severe traumatic brain injury: A systematic review and meta-analysis of randomised controlled trials
    Marwan Bouras, Frédérique Lamothe-Boucher, Jihad Abou Jamous +9
    Critical care and resuscitation : journal of the Australasian Academy of Critical Care MedicinePeer-reviewedCC BY-NC-NDFull textGeneral medicineEurope PMC
  3. MRI improves global outcome prediction after moderate or severe traumatic brain injury
    H. Shi, W. H. Curley, M. Gjyzari +21
    medRxivPreprintAll rights reservedFull textNeurologymedRxiv
  4. Preoperative Intranasal Oxytocin and Probable Acute Stress Disorder After Traumatic Fracture Surgery
    Qingqing Huang, Yi Wen, Qin Li +10
    JAMA Internal MedicinePeer-reviewedLicence not statedFull textPsychiatry & mental healthPMC
  5. Intraoperative Proximal Fibula Fracture during Total Knee Arthroplasty for Moderate Valgus Knee Deformity: A Case Report.
    Siddharth Khadilkar, Ronak J Mahatme, Shawn Moore +3
    Journal of orthopaedic case reportsPeer-reviewedCC BY-NCFull textSurgery & anaesthesiaEurope PMC

Cite

BibTeXRIS
BibTeX
@article{zhan2026transsinus,
  title = {{Trans-sinus fracture as the gatekeeper: a two-step clinical strategy to guide venous imaging in mild-to-moderate traumatic brain injury}},
  author = {Jincheng Zhan and Xiangrong Chen and Bikun Liu and Xiaofeng Zhou and Dongze Xu and Zongtao Wu},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1901656},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1901656/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Trans-sinus fracture as the gatekeeper: a two-step clinical strategy to guide venous imaging in mild-to-moderate traumatic brain injury
AU  - Jincheng Zhan
AU  - Xiangrong Chen
AU  - Bikun Liu
AU  - Xiaofeng Zhou
AU  - Dongze Xu
AU  - Zongtao Wu
PY  - 2026
DA  - 2026/10/22
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1901656
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1901656/full
AB  - Background: Traumatic cerebral venous sinus thrombosis (tCVST) is an underrecognized complication of traumatic brain injury (TBI). Despite its potential for serious neurological sequelae, no consensus exists regarding indications for CT venography (CTV) or MR venography (MRV) in patients with mild-to-moderate TBI. Trans-sinus fracture has been identified as a risk factor for tCVST, yet its predictive value alone remains insufficient to guide clinical decision-making.  Objective: To propose a two-step clinical decision strategy for guiding venous imaging selection in mild-to-moderate TBI, using trans-sinus fracture as a gatekeeper followed by D-dimer and headache visual analog scale (VAS) score stratification.  Methods: This single-center retrospective cohort study included 528 patients with mild-to-moderate TBI (Glasgow Coma Scale score > 8) who underwent CTV, MRV, or digital subtraction angiography between January 2024 and January 2026. Firth penalized logistic regression was employed to identify tCVST predictors. A two-step strategy was derived: Step 1 screened for trans-sinus fracture; Step 2 applied D-dimer threshold ≥ 3.95 mg/L or headache VAS score ≥ 3 in trans-sinus fracture-positive patients.  Results: Traumatic cerebral venous sinus thrombosis was diagnosed in 41 patients (7.8%). Trans-sinus fracture was independently associated with tCVST (odds ratio 8.44, 95% confidence interval 4.38–16.39; P < 0.0001). As a standalone gatekeeper, trans-sinus fracture yielded sensitivity 58.5%, specificity 89.1%, negative predictive value 96.3%, and positive likelihood ratio 3.96. Among trans-sinus fracture-positive patients, the high-risk subgroup (D-dimer ≥ 3.95 mg/L or VAS ≥ 3) exhibited a tCVST rate of 31.2%, compared with 4.3% in the low-risk subgroup. The two-step strategy achieved a number needed to image of 3, avoiding 85% of unnecessary venous examinations compared with universal screening, and reduced the number needed to image from 13 (universal approach) to 3 (two-step approach).  Conclusions: This two-step strategy represents a simple, bedside-ready exploratory tool that may help optimize CTV/MRV selection in mild-to-moderate TBI by identifying a high-yield subgroup for targeted imaging. These findings are hypothesis-generating and require prospective external validation before clinical implementation.
SN  - 1664-2295
ER  -