Traumatic cerebral venous sinus thrombosis is uniformly common across skull fracture patterns in blunt head trauma

Background Traumatic cerebral venous sinus thrombosis (tCVST) is a recognized complication of traumatic brain injury (TBI) with important clinical implications. Although temporal bone fractures are associated with tCVST, the contribution of other skull fracture patterns remains unclear. We hypothesized that all skull fractures confer risk of tCVST and sought to quantify this risk across different fracture patterns. Methods This was a retrospective review of adult blunt-mechanism TBI with ≥ 1 skull fracture admitted to a Level 1 trauma center over an 11-year period. The primary outcome was tCVST. Patients who did not undergo venous-phase imaging were considered indeterminate and excluded. Candidate predictors were identified via univariable analysis; multivariable regression was used to estimate independent predictors of tCVST. Results Among 673 eligible patients, 428 had definitive imaging; 147 had tCVST and 281 were confirmed tCVST-negative. tCVST patients were younger (40.3 vs 45.7 years, p  = 0.006) and had higher Injury Severity Scores (22.7 vs 19.8, p  = 0.004). tCVST prevalence increased with head AIS (0% in AIS 2, 19.6% in AIS 3, 42.1% in AIS 4, and 44.4% in AIS 5; p  < 0.001). Temporal fractures were associated with tCVST (42.0% vs. 24.2%, p < 0.001) , as was fracture burden (1 region = 25.9%, 5 regions = 66.7%, p = 0.002). Isolated temporal (33.3%), occipital (27.3%), frontal (23.5%), and parietal (16.7%) fractures also increased risk. On multivariable analysis, independent predictors of tCVST included head AIS (OR 4.48, 95% CI 1.41–14.26), temporal fracture (OR 8.0, 95% CI 2.14–29.99), and male sex (OR 6.45, 95% CI 1.1–37.3). Conclusions tCVST occurred at high rates across all fracture patterns, with no reliably low-risk subgroup. These findings suggest that routine venous-phase imaging should be considered in adults with moderate or severe TBI and any skull fracture, rather than selective imaging based on fracture location alone. Level of Evidence/Study Type: Level IV, Diagnostic test/criteria