Incidence of blunt cerebrovascular injury in low-risk cervical spine fractures

Kopelman, Tammy R.; Leeds, Steven G.; Berardoni, Nicole E.; O’Neill, Patrick J.; Hedayati, Poya; Vail, Sydney J.; Pieri, Paola G.; Feiz-Erfan, Iman; Pressman, Melissa A.

doi:10.1016/j.amjsurg.2011.06.033

Cited by 30 publications

(12 citation statements)

References 17 publications

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“…23,26–28,30,32 Originally thought to be benign, VAI has been shown to confer a small but significant stroke risk. 4,5,22 Trauma centers throughout the United States have begun implementing protocols to screen for cerebrovascular injury using CTA among those patients with penetrating injuries, LeFort II/III fractures, high-risk Denver Criteria cervical spine fractures, temporal bone fractures involving the carotid canal, and for unexplained ischemic events.…”

Section: Discussionmentioning

confidence: 99%

Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center

Lockwood

Smith

Tanenbaum

et al. 2016

SPI

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OBJECT Screening for vertebral artery injury (VAI) following cervical spine fractures is routinely performed across trauma centers in North America. From 2002 to 2007, the total number of neck CT angiography (CTA) studies performed in the Medicare population after trauma increased from 9796 to 115,021. In the era of cost-effective medical care, the authors aimed to evaluate the utility of CTA screening in detecting VAI and reduce chances of posterior circulation strokes after traumatic cervical spine fractures. METHODS A retrospective review of all patients presenting with cervical spine fractures to Northeast Ohio’s Level I trauma institution from 2002 to 2012 was performed. RESULTS There was a total of 1717 cervical spine fractures in patients presenting to Northeast Ohio’s Level I trauma institution between 2002 and 2012. CTA screening was performed in 732 patients, and 51 patients (0.7%) were found to have a VAI. Fracture patterns with increased odds of VAI were C-1 and C-2 combined fractures, transverse foramen fractures, and subluxation of adjacent vertebral levels. Ten posterior circulation strokes were identified in this patient population (0.6%) and found in only 4 of 51 cases of VAI (7.8%). High-risk fractures defined by Denver Criteria, VAI, and antiplatelet treatment of VAI were not independent predictors of stroke. CONCLUSIONS Cost-effective screening must be reevaluated in the setting of blunt cervical spine fractures on a case-by-case basis. Further prospective studies must be performed to elucidate the utility of screening for VAI and posterior circulation stroke prevention, if identified.

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Section: Discussionmentioning

confidence: 99%

Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center

Lockwood

Smith

Tanenbaum

et al. 2016

SPI

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“…Patients with blunt trauma with a high-velocity mechanism, low Glasgow Coma Scale score, high injury severity score, mandible fracture, complex skull fractures, basilar skull fractures (including carotid canal fractures), scalp degloving, any type of cervical spine injury, traumatic brain injury with thoracic injuries, and/or thoracic vascular imaging are at increased risk for blunt neurovascular injuries (evidence level II). 148,[151][152][153][154] In patients identified as having these types of concurrent injuries, the overall rate of blunt neurovascular injuries increases up to 27%-30%. 147 Although digital subtraction angiography is the diagnostic reference standard for detecting blunt neurovascular injuries, a number of retrospective studies and meta-analyses indicate that multidetector CT angiography is an accurate, rapid, noninvasive diagnostic alternative.…”

Section: Imaging Of Neurovascular Traumamentioning

confidence: 99%

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Wintermark

Sanelli

Anzai

et al. 2014

AJNR Am J Neuroradiol

112

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SUMMARY:Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge. ABBREVIATIONS:BOLD ϭ blood oxygen level-dependent; FA ϭ fractional anisotropy; MD ϭ mean diffusivity; MEG ϭ magnetoencephalography; TBI ϭ traumatic

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“…Four studies reported the number of BCVIs with high-risk factors, and the weighted average was obtained to extrapolate the incidence of BCVI in high-risk patients. 1,[6][7][8]18 The proportion of high-risk populations in all blunt trauma admissions was derived from the weighted average of 2 studies totaling nearly 30,000 patients. 6,7…”

Section: Clinical Parametersmentioning

confidence: 99%

Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

Malhotra¹,

Wu²,

Kalra³

et al. 2015

AJNR Am J Neuroradiol

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Incidence of blunt cerebrovascular injury in low-risk cervical spine fractures

Cited by 30 publications

References 17 publications

Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center

Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center

Imaging Evidence and Recommendations for Traumatic Brain Injury: Advanced Neuro- and Neurovascular Imaging Techniques

Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

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