Cervical spine fracture patterns mandating screening to rule out blunt cerebrovascular injury

Background Aggressive screening for blunt cerebrovascular injury (BCVI) and prompt anticoagulation for documented injuries has resulted in a significant reduction in ischemic neurologic events. An association between vertebral artery injuries (VAIs) and specific cervical spine fracture patterns has...

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Veröffentlicht in:Surgery 2007, Vol.141 (1), p.76-82
Hauptverfasser: Cothren, C. Clay, MD, Moore, Ernest E., MD, Ray, Charles E., MD, Johnson, Jeffrey L., MD, Moore, John B., MD, Burch, Jon M., MD
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container_end_page 82
container_issue 1
container_start_page 76
container_title Surgery
container_volume 141
creator Cothren, C. Clay, MD
Moore, Ernest E., MD
Ray, Charles E., MD
Johnson, Jeffrey L., MD
Moore, John B., MD
Burch, Jon M., MD
description Background Aggressive screening for blunt cerebrovascular injury (BCVI) and prompt anticoagulation for documented injuries has resulted in a significant reduction in ischemic neurologic events. An association between vertebral artery injuries (VAIs) and specific cervical spine fracture patterns has been suggested; however, current screening guidelines would subject all patients with cervical spine fractures to imaging because no distinction has been made for carotid artery injuries (CAIs). We hypothesized that specific cervical spine fracture patterns that warrant screening evaluation exist, hence limiting unwarranted diagnostic imaging. Methods Patients undergoing screening for BCVI on the basis of injury patterns and mechanism have been prospectively followed at our regional trauma center since January 1996. Results During the study period from January 1996 to January 2005, there were 17,007 blunt trauma admissions. Twenty-three patients presented with symptoms of BCVI. Screening angiography was performed in 766 patients (4.5%), and diagnosed 258 (34%) patients with BCVI. One hundred twenty-five patients with BCVI had cervical spine fractures; 18 patients had isolated CAI; 84 had isolated VAI, and 23 had combined CAI and VAI. Eight patients with VAI had minor cervical fractures but underwent screening for other injury patterns. Fractures in the remaining patients with BCVI were 1 of 3 patterns. Subluxations in 56 (48%) patients, C1 to C3 cervical spine fractures in 42 (36%), or extension of the fracture through the foramen transversarium in 19 (16%). Cervical spine fractures were the sole indication for screening in 90% of the study population. Screening yield of all patients admitted with 1 of these 3 fracture patterns was 37%. Conclusions Blunt cerebrovascular injury is associated with complex cervical spine fractures that include subluxation, extension into the foramen transversarium, or upper C1 to C3 fractures. Patients sustaining such cervical fractures should undergo prompt screening.
doi_str_mv 10.1016/j.surg.2006.04.005
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Clay, MD ; Moore, Ernest E., MD ; Ray, Charles E., MD ; Johnson, Jeffrey L., MD ; Moore, John B., MD ; Burch, Jon M., MD</creator><creatorcontrib>Cothren, C. Clay, MD ; Moore, Ernest E., MD ; Ray, Charles E., MD ; Johnson, Jeffrey L., MD ; Moore, John B., MD ; Burch, Jon M., MD</creatorcontrib><description>Background Aggressive screening for blunt cerebrovascular injury (BCVI) and prompt anticoagulation for documented injuries has resulted in a significant reduction in ischemic neurologic events. An association between vertebral artery injuries (VAIs) and specific cervical spine fracture patterns has been suggested; however, current screening guidelines would subject all patients with cervical spine fractures to imaging because no distinction has been made for carotid artery injuries (CAIs). We hypothesized that specific cervical spine fracture patterns that warrant screening evaluation exist, hence limiting unwarranted diagnostic imaging. Methods Patients undergoing screening for BCVI on the basis of injury patterns and mechanism have been prospectively followed at our regional trauma center since January 1996. Results During the study period from January 1996 to January 2005, there were 17,007 blunt trauma admissions. Twenty-three patients presented with symptoms of BCVI. Screening angiography was performed in 766 patients (4.5%), and diagnosed 258 (34%) patients with BCVI. One hundred twenty-five patients with BCVI had cervical spine fractures; 18 patients had isolated CAI; 84 had isolated VAI, and 23 had combined CAI and VAI. Eight patients with VAI had minor cervical fractures but underwent screening for other injury patterns. Fractures in the remaining patients with BCVI were 1 of 3 patterns. Subluxations in 56 (48%) patients, C1 to C3 cervical spine fractures in 42 (36%), or extension of the fracture through the foramen transversarium in 19 (16%). Cervical spine fractures were the sole indication for screening in 90% of the study population. Screening yield of all patients admitted with 1 of these 3 fracture patterns was 37%. Conclusions Blunt cerebrovascular injury is associated with complex cervical spine fractures that include subluxation, extension into the foramen transversarium, or upper C1 to C3 fractures. Patients sustaining such cervical fractures should undergo prompt screening.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2006.04.005</identifier><identifier>PMID: 17188170</identifier><identifier>CODEN: SURGAZ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adult ; Biological and medical sciences ; Carotid Artery Injuries - diagnosis ; Carotid Artery Injuries - diagnostic imaging ; Cerebral Angiography ; Cerebrovascular Trauma - diagnosis ; Cerebrovascular Trauma - diagnostic imaging ; Cervical Vertebrae - injuries ; Colorado ; Female ; General aspects ; Head Injuries, Closed - diagnosis ; Head Injuries, Closed - diagnostic imaging ; Humans ; Male ; Medical sciences ; Prevention and actions ; Public health. Hygiene ; Public health. 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Clay, MD</creatorcontrib><creatorcontrib>Moore, Ernest E., MD</creatorcontrib><creatorcontrib>Ray, Charles E., MD</creatorcontrib><creatorcontrib>Johnson, Jeffrey L., MD</creatorcontrib><creatorcontrib>Moore, John B., MD</creatorcontrib><creatorcontrib>Burch, Jon M., MD</creatorcontrib><title>Cervical spine fracture patterns mandating screening to rule out blunt cerebrovascular injury</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Aggressive screening for blunt cerebrovascular injury (BCVI) and prompt anticoagulation for documented injuries has resulted in a significant reduction in ischemic neurologic events. An association between vertebral artery injuries (VAIs) and specific cervical spine fracture patterns has been suggested; however, current screening guidelines would subject all patients with cervical spine fractures to imaging because no distinction has been made for carotid artery injuries (CAIs). We hypothesized that specific cervical spine fracture patterns that warrant screening evaluation exist, hence limiting unwarranted diagnostic imaging. Methods Patients undergoing screening for BCVI on the basis of injury patterns and mechanism have been prospectively followed at our regional trauma center since January 1996. Results During the study period from January 1996 to January 2005, there were 17,007 blunt trauma admissions. Twenty-three patients presented with symptoms of BCVI. Screening angiography was performed in 766 patients (4.5%), and diagnosed 258 (34%) patients with BCVI. One hundred twenty-five patients with BCVI had cervical spine fractures; 18 patients had isolated CAI; 84 had isolated VAI, and 23 had combined CAI and VAI. Eight patients with VAI had minor cervical fractures but underwent screening for other injury patterns. Fractures in the remaining patients with BCVI were 1 of 3 patterns. Subluxations in 56 (48%) patients, C1 to C3 cervical spine fractures in 42 (36%), or extension of the fracture through the foramen transversarium in 19 (16%). Cervical spine fractures were the sole indication for screening in 90% of the study population. Screening yield of all patients admitted with 1 of these 3 fracture patterns was 37%. Conclusions Blunt cerebrovascular injury is associated with complex cervical spine fractures that include subluxation, extension into the foramen transversarium, or upper C1 to C3 fractures. 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Hygiene-occupational medicine</subject><subject>Spinal Fractures - diagnosis</subject><subject>Spinal Fractures - diagnostic imaging</subject><subject>Surgery</subject><subject>Trauma Centers</subject><subject>Vertebral Artery - diagnostic imaging</subject><subject>Vertebral Artery - injuries</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2LFDEQhoMo7rj6BzxILnrrsZLuTveACDL4BQse1KOEdHVlSduTHvMxMP_eNDOw4EEIVA7PW1Q9xdhLAVsBQr2dtjGH-60EUFtotgDtI7YRbS2rrlbiMdsA1LtKgYIb9izGCQB2jeifshvRib4XHWzYrz2Fk0Mz83h0nrgNBlMOxI8mJQo-8oPxo0nO3_OIgcivv7TwkGfiS058mLNPHCnQEJaTiZhnE7jzUw7n5-yJNXOkF9d6y35--vhj_6W6-_b56_7DXYUttKkSIxiUaGCAobGIrVVIjaKykR2srAGNaEZhGzAgVWuNAdFKq6yQYHdI9S17c-l7DMufTDHpg4tI82w8LTlq1dc91F1fQHkBMSwxBrL6GNzBhLMWoFepetKrVL1K1dDoMkIJvbp2z8OBxofI1WIBXl-Bsr6Zi0OPLj5wfS9l3ajCvbtwVFycHAUd0ZFHGl0gTHpc3P_neP9PHGfn1-P9pjPFacnBF8ta6Cg16O_r-dfrr0920NR_ASEtrKo</recordid><startdate>2007</startdate><enddate>2007</enddate><creator>Cothren, C. Clay, MD</creator><creator>Moore, Ernest E., MD</creator><creator>Ray, Charles E., MD</creator><creator>Johnson, Jeffrey L., MD</creator><creator>Moore, John B., MD</creator><creator>Burch, Jon M., MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2007</creationdate><title>Cervical spine fracture patterns mandating screening to rule out blunt cerebrovascular injury</title><author>Cothren, C. Clay, MD ; Moore, Ernest E., MD ; Ray, Charles E., MD ; Johnson, Jeffrey L., MD ; Moore, John B., MD ; Burch, Jon M., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c505t-1d0ac2ca0b0b4fcc5f6ce46e005fbf230ca14d1f40a0265faa0152f6f120f9ce3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Carotid Artery Injuries - diagnosis</topic><topic>Carotid Artery Injuries - diagnostic imaging</topic><topic>Cerebral Angiography</topic><topic>Cerebrovascular Trauma - diagnosis</topic><topic>Cerebrovascular Trauma - diagnostic imaging</topic><topic>Cervical Vertebrae - injuries</topic><topic>Colorado</topic><topic>Female</topic><topic>General aspects</topic><topic>Head Injuries, Closed - diagnosis</topic><topic>Head Injuries, Closed - diagnostic imaging</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Prevention and actions</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Spinal Fractures - diagnosis</topic><topic>Spinal Fractures - diagnostic imaging</topic><topic>Surgery</topic><topic>Trauma Centers</topic><topic>Vertebral Artery - diagnostic imaging</topic><topic>Vertebral Artery - injuries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cothren, C. Clay, MD</creatorcontrib><creatorcontrib>Moore, Ernest E., MD</creatorcontrib><creatorcontrib>Ray, Charles E., MD</creatorcontrib><creatorcontrib>Johnson, Jeffrey L., MD</creatorcontrib><creatorcontrib>Moore, John B., MD</creatorcontrib><creatorcontrib>Burch, Jon M., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cothren, C. Clay, MD</au><au>Moore, Ernest E., MD</au><au>Ray, Charles E., MD</au><au>Johnson, Jeffrey L., MD</au><au>Moore, John B., MD</au><au>Burch, Jon M., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cervical spine fracture patterns mandating screening to rule out blunt cerebrovascular injury</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2007</date><risdate>2007</risdate><volume>141</volume><issue>1</issue><spage>76</spage><epage>82</epage><pages>76-82</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><coden>SURGAZ</coden><abstract>Background Aggressive screening for blunt cerebrovascular injury (BCVI) and prompt anticoagulation for documented injuries has resulted in a significant reduction in ischemic neurologic events. An association between vertebral artery injuries (VAIs) and specific cervical spine fracture patterns has been suggested; however, current screening guidelines would subject all patients with cervical spine fractures to imaging because no distinction has been made for carotid artery injuries (CAIs). We hypothesized that specific cervical spine fracture patterns that warrant screening evaluation exist, hence limiting unwarranted diagnostic imaging. Methods Patients undergoing screening for BCVI on the basis of injury patterns and mechanism have been prospectively followed at our regional trauma center since January 1996. Results During the study period from January 1996 to January 2005, there were 17,007 blunt trauma admissions. Twenty-three patients presented with symptoms of BCVI. Screening angiography was performed in 766 patients (4.5%), and diagnosed 258 (34%) patients with BCVI. One hundred twenty-five patients with BCVI had cervical spine fractures; 18 patients had isolated CAI; 84 had isolated VAI, and 23 had combined CAI and VAI. Eight patients with VAI had minor cervical fractures but underwent screening for other injury patterns. Fractures in the remaining patients with BCVI were 1 of 3 patterns. Subluxations in 56 (48%) patients, C1 to C3 cervical spine fractures in 42 (36%), or extension of the fracture through the foramen transversarium in 19 (16%). Cervical spine fractures were the sole indication for screening in 90% of the study population. Screening yield of all patients admitted with 1 of these 3 fracture patterns was 37%. Conclusions Blunt cerebrovascular injury is associated with complex cervical spine fractures that include subluxation, extension into the foramen transversarium, or upper C1 to C3 fractures. Patients sustaining such cervical fractures should undergo prompt screening.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>17188170</pmid><doi>10.1016/j.surg.2006.04.005</doi><tpages>7</tpages></addata></record>
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subjects Adult
Biological and medical sciences
Carotid Artery Injuries - diagnosis
Carotid Artery Injuries - diagnostic imaging
Cerebral Angiography
Cerebrovascular Trauma - diagnosis
Cerebrovascular Trauma - diagnostic imaging
Cervical Vertebrae - injuries
Colorado
Female
General aspects
Head Injuries, Closed - diagnosis
Head Injuries, Closed - diagnostic imaging
Humans
Male
Medical sciences
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Spinal Fractures - diagnosis
Spinal Fractures - diagnostic imaging
Surgery
Trauma Centers
Vertebral Artery - diagnostic imaging
Vertebral Artery - injuries
title Cervical spine fracture patterns mandating screening to rule out blunt cerebrovascular injury
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