257. Patient specific predictive factors of vertebral artery injury following blunt cervical spine trauma

Abstract

<h3>BACKGROUND CONTEXT</h3> Computed topography angiography (CTA) is routinely used in evaluation for vascular injury in patients that have sustained blunt cervical spine trauma. Current screening criteria often leads to over utilization of imaging in patients who are already receiving antithrombic therapy or have clear contraindications due to concomitant injuries. <h3>PURPOSE</h3> This study sought to identify patient and injury characteristics predictive of vascular injury (VAI) in blunt cervical spine trauma in order to identify high-risk patients and propose alternative screening criteria. <h3>STUDY DESIGN/SETTING</h3> This was a retrospective cohort study collected from patients presenting for blunt cervical spine injury between 2014-2018 at a level I trauma tertiary care center. <h3>PATIENT SAMPLE</h3> A total of 475 patients over the age of 18 who sustained blunt cervical spine trauma and had available cervical spine CT were included in analysis. <h3>OUTCOME MEASURES</h3> 1) Incidence of vertebral artery injuries (VAI) in blunt cervical spine injury. 2) In patients with VAI, percentage of patients with contraindication to anti-platelet therapy OR receiving anti-platelet therapy prior to injury. 3) In patients with VAI, percentage of patients that developed acute kidney injury. 4) Injury and patient characteristics associated with higher risk of sustaining VAI. <h3>METHODS</h3> This was a retrospective cohort study collected from patients presenting for blunt cervical spine injury between 2014-2018. Patients were included who sustained a cervical spine injury and cervical spine CT was available. Demographics including age, gender, outpatient aspirin use, presence of kidney disease was recorded. Injury characteristics including mechanism of action, level of cervical spine injury, type of injury, concomitant thoracic and/or lumbar spine injury, if CTA was obtained, presence of VAI, operative interventions, and subaxial-cervical spine injury classification (SLIC) was collected. Data was evaluated using univariate and multivariate analyses to determine risk factors for VAI. <h3>RESULTS</h3> A total of 475 patients were included, average age 60.2 years. Motor vehicle accident was the most common cause of injury in 225 (47.4%) patients. CTA of the neck was performed in 264 (55.5%) patients. In patients who received CTA, 48 (18.2%) had a contraindication to receiving anti-platelet therapy and 66 (25%) were already receiving anti-platelet therapy as an outpatient medication. 26 (5.5%) patients were found to have VAI, and in patients with VAI, 4 (14.3%) patents were already receiving ASA as an outpatient medication, and no patients required secondary vascular interventions. Acute kidney injury was found in 28 (10.5%) patients who had received CTA. Factors associated with greater odds of having VAI included transverse foramen involvement (OR4.27, CI 2.05-8.89, p=0.0001), multilevel cervical spine fractures (OR2.09, CI 0.97-4.99), subluxation/displacement/dislocation of fracture (OR2.23, CI 1.08-4.59,p=0.03), high energy mechanism (OR2.38, CI 1.14-4.96), SLIC score >4 (OR2.65, CI 1.07-6.55,p=0.04), and concomitant lumbar spine injury (OR4.37, CI 1.13-16.9,p=0.03). <h3>CONCLUSIONS</h3> Updated protocols utilizing evidence-based clinical parameters to predict chance of VAI may avoid unnecessary advanced imaging and contrast load to patients in the setting of blunt cervical spine trauma. Further prospective studies are needed to determine if identified risk factors could be used as specific screening criteria to identify high-risk patients who would benefit most from further advanced imaging. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.