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  • Predictors of Vertebral and Carotid Artery Dissection during Blunt Trauma: Experience in a Level I Trauma Center

    Final Number:
    1374

    Authors:
    Sayantan Deb BA; Allen Ho MD; Lily kim BA; Anshul Haldipur MD; Stephanie Lin; Mahesh Patel MD; Harminder Singh MD, FACS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Various studies have sought to identify factors associated with vertebral and carotid artery dissection in a trauma setting [1,2]. However, these models are controversial, and efforts continue to optimize these predictors.

    Methods: 950 patients, who underwent CT-angiography in Santa Clara Valley Medical Center Emergency Department between 2009-2014, were included in this study. 515 patients were excluded because they were non-trauma cases, or had penetrating injuries. 435 patients were analyzed, who all underwent neck CTA for blunt traumatic injuries. Mechanism of injury was classified as high- and low-impact, based on county guidelines for major and minor trauma. A positive neurological sign included altered mental status (GCS<15 or less than baseline) or focal neurological deficits. Fractures and dissections were radiologically confirmed. Multivariable logistic regression was used to analyze data with SAS v9.4.

    Results: Of 435 patients, 35.86% were female and 54.25% experienced high-impact injuries. 28.51% had vertebral fractures, of which 50.81% were displaced. 41.38% patients had a positive neurologic sign on presentation. 9 (2%) patients were diagnosed with carotid artery dissections, and 16 (3.7%) had vertebral artery dissections. There were no significant associations between positive neurologic sign, age, sex, mechanism of injury, or vertebral fracture for carotid artery injury (all p>0.05). Positive neurologic signs and vertebral fractures were significant predictors of vertebral artery dissection (OR=5.46, p<0.01; OR=8.44, p<0.001 respectively). Age, sex, mechanism of injury, or displacement of vertebral fracture were not significant predictors of vertebral artery injury (all p>0.05).

    Conclusions: These findings from a large cohort of patients with blunt traumatic injury at a single trauma center show that positive neurologic signs and presence of vertebral fractures (displaced or non-displaced) are significant predictors of vertebral artery injuries. This underscores potential avenues to optimize screening tools for such injuries.

    Patient Care: This research gives insight into factors that can guide screening tools for vertebral and carotid artery dissection in the trauma setting.

    Learning Objectives: 1) Neurologic deficits is a significant predictor of vertebral artery dissection in a trauma setting. 2) Mechanism of injury (high or low impact) is not an independent predictor of arterial dissection. 3) Vertebral fractures (displaced and non-displaced) are a significant predictor of vertebral artery dissection, while vertebral body dislocation/displacement by itself is not.

    References: 1) Lockwood MM, Smith GA, Tanenbaum J, Lubelski D, Seicean A, Pace J, Benzel EC, Mroz TE, Steinmetz MP. Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center. J Neurosurg Spine. 2016 Mar;24(3):490-5. doi: 10.3171/2015.6.SPINE15140. PubMed PMID: 26613284. 2) Delgado Almandoz JE, Schaefer PW, Kelly HR, Lev MH, Gonzalez RG, Romero JM. Multidetector CT angiography in the evaluation of acute blunt head and neck trauma: a proposed acute craniocervical trauma scoring system. Radiology. 2010 Jan;254(1):236-44. doi: 10.1148/radiol.09090693. PubMed PMID: 20019135.

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