Predictors of Cervical Vertebral and Carotid Artery Dissection During Blunt Trauma: Experience From a Level 1 Trauma Center

Allen L Ho; Sayantan Deb; Lily H Kim; Anshul Haldipur; Stephanie Lin; Mahesh Patel; Harminder Singh

doi:10.1016/j.wneu.2020.01.191

Predictors of Cervical Vertebral and Carotid Artery Dissection During Blunt Trauma: Experience From a Level 1 Trauma Center

World Neurosurg. 2020 May:137:e315-e320. doi: 10.1016/j.wneu.2020.01.191. Epub 2020 Feb 3.

Authors

Allen L Ho¹, Sayantan Deb¹, Lily H Kim¹, Anshul Haldipur², Stephanie Lin², Mahesh Patel², Harminder Singh³

Affiliations

¹ Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
² Division of Radiology, Santa Clara Valley Medical Center, San Jose, California, USA.
³ Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Division of Neurosurgery, Santa Clara Valley Medical Center, San Jose, California, USA. Electronic address: Harman@stanford.edu.

PMID: 32028007
DOI: 10.1016/j.wneu.2020.01.191

Abstract

Background: The current data available to identify the factors associated with vertebral and carotid artery dissection in the trauma setting are conflicting, and further research is needed to accurately assess these predictors.

Methods: The data from 950 patients who had undergone neck computed tomography angiography (CTA) at a level 1 trauma center were analyzed. Of the 950 patients, 435 were included who had undergone neck CTA for blunt traumatic injuries. The mechanism of injury was classified as high or low impact according to the hospital criteria for trauma. Positive neurological signs included altered mental status (Glasgow coma scale score ≤15 than baseline) or focal neurological deficits. Fractures and dissections were radiologically confirmed. Multivariable logistic regression software was used to analyze the data.

Results: Of the 435 patients, 236 (54.25%) had experienced high-impact injuries, 124 (28.51%) had vertebral fractures (including 63 displaced fractures [50.81%]), and 180 (41.38%) had had positive neurological signs on presentation. Of the 435 patients, cervical carotid artery injury had been diagnosed in 9 (2.07%), and 18 patients (4.14%) had had a cervical vertebral artery injury (VAI). Carotid artery injuries did not have significant associations with positive neurological signs, age, sex, mechanism of injury, or vertebral fracture (P > 0.05 for all). Positive neurological signs and vertebral fractures were significant predictors for VAI (odds ratio, 3.19; P < 0.05; odds ratio, 9.81; P < 0.001, respectively). Age, sex, mechanism of injury, and displacement of the vertebral fracture were not significant predictors for VAI (P > 0.05 for all).

Conclusions: Positive neurological signs and the presence of cervical vertebral fractures are significant predictors for VAI. All trauma patients with cervical spine fractures and/or positive neurological findings should be considered for surveillance imaging with neck CTA and/or magnetic resonance angiography for vascular injury screening.

Keywords: Blunt injury; Carotid; Computed tomography angiography; Dissection; Trauma; Vertebral.

MeSH terms

Adult
Carotid Artery, Internal, Dissection / diagnostic imaging*
Carotid Artery, Internal, Dissection / etiology*
Computed Tomography Angiography / methods
Female
Humans
Magnetic Resonance Angiography / methods
Male
Retrospective Studies
Trauma Centers
Vertebral Artery Dissection / diagnostic imaging*
Vertebral Artery Dissection / etiology*
Wounds, Nonpenetrating / complications*
Wounds, Nonpenetrating / diagnostic imaging*