Vertebral artery injury in major trauma patients in Saudi Arabia: A retrospective cohort study

Sharfuddin Chowdhury,Khadega Hadi Binsaad,Mark Fitzgerald,Sadiq Hussain Almubarak,Biswadev Mitra

doi:10.1038/s41598-020-73238-2

Abstract

Blunt vertebral artery injury (VAI) is associated with severe cervicocephalic trauma and may have devastating consequences. This study aimed to determine the incidence and nature of VAI in polytrauma patients. The secondary objective was to assess the association of VAI with previously suggested risk factors. It was a retrospective observational study of all polytrauma patients admitted to the trauma unit between April 2018 and July 2019, who had CT neck angiography to diagnose blunt VAI according to modified Denver criteria. Out of 1084 admitted polytrauma patients, 1025 (94.6%) sustained blunt trauma. Of these, 120 (11.7%) underwent screening CT neck angiography. VAI was detected in 10 (8.3%; 95% CI 4.1–14.8) patients. There were three patients with Grade I injury, two with Grade II, and five with Grade IV injury. Among all trauma admissions, the incidence of diagnosed VAI was 0.9% (95% CI 0.5–1.8). Among patients suspected of VAI, there was no univariable association of VAI with C-Spine fracture: OR 4.2 (95% CI 0.51–34.4; p = 0.18). There were two (20%) deaths related to VAI. Traumatic VAI was uncommonly detected in this major trauma service in Saudi Arabia. High suspicion and liberal screening by CT angiography in cases where VAI is possible should be considered to avoid missed injuries.

Highlights

Blunt vertebral artery injury (VAI) is associated with severe cervicocephalic trauma and may have devastating consequences
If the whole-body CT report suggests Blunt cerebrovascular injury (BCVI) according to modified Denver criteria, we investigate further with a neck CT angiogram
The study was approved by the Institutional Review Board (IRB) of the King Saud Medical City (KSMC) with a reference number of H1R1-08-Apr[]

Summary

Introduction

Blunt vertebral artery injury (VAI) is associated with severe cervicocephalic trauma and may have devastating consequences. The secondary objective was to assess the association of VAI with previously suggested risk factors It was a retrospective observational study of all polytrauma patients admitted to the trauma unit between April 2018 and July 2019, who had CT neck angiography to diagnose blunt VAI according to modified Denver criteria. A high index of suspicion for VAI, based on the mechanism of trauma and the nature of associated injuries, should be considered. The reported incidence is highly variable in the literature (0.5–2% of all trauma patients)[5] For those reasons, there have been several screening criteria set up for the detection of VAI, including the Denver, Memphis, and Boston criteria based on injury mechanism, injury pattern, and symptoms[6,7,8,9,10]. It has been suggested that early diagnosis and management (conservative versus interventional) may improve outcomes

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