Wednesday, September 26, 2018 10:35 AM – 12:00 PM Cervical Spine Trauma: 26. The clinical implications of adding computed tomography angiography in the evaluation of cervical spine fractures: a propensity matched analysis

Abstract

BACKGROUND CONTEXT Screening asymptomatic blunt trauma patients for cervical arterial injury is controversial. Vertebral artery injury (VAI) is most commonly associated with cervical spine fracture and some guidelines advocate indiscriminate screening of all cervical spine fractures. PURPOSE To determine whether the addition of computed tomography angiography (CT-A) resulted in a change in management for patients with cervical spine fractures. STUDY DESIGN/SETTING Propensity score matching cohort study. Participants of this study originated from two large academic trauma centers located in a single city. PATIENT SAMPLE Adult patients with acute cervical spine fractures sustained after blunt trauma between 2000 and 2015 were included. Patients with penetrating trauma, neoplasm and prior cervical spine surgery were excluded. There were 3,943 patients screened for inclusion and 2,831 patients eligible. OUTCOME MEASURES Recommendation for a change in management with antithrombosis was the primary outcome measure. Detection of stroke and vertebral artery injury were secondary outcomes. METHODS Demographic data, cervical spine fracture characteristics, utilization of CT-A, presence of vertebral artery injury and outcome were extracted from the medical record. Logistic regression identified factors associated with obtaining a CT-A. Propensity score matching was performed to negate the significant baseline characteristic differences including age, race, medical comorbidities, injury burden, mechanism of injury, upper cervical spine fracture, foramen transversarium involvement, multilevel involvement and associated facet dislocation. This resulted in one cohort receiving CT-A and one cohort that did not, both with 644 patients and equivalent demographic and clinical characteristics. The score matched patients who obtained CT-A with those who obtained CT alone to create two statistically equivalent cohorts. RESULTS In the matched cohorts, average age was 59 years and 57% of each cohort was male. CT-A identified definite or indeterminate VAI in 113 patients and 62 patients had antithrombosis recommended. In the cohort without CT-A, VAI was discovered in 11 patients incidentally through other imaging and eight were recommended antithrombosis. Two patients in the CT-A group had major adverse bleeding events as a result of antithrombosis initiation. There were no preventable strokes in either group. CONCLUSIONS The addition of CT-A increased the detection of VAI and antithrombosis recommendation. There was a high incidence of indeterminate CT-A findings. There were no preventable strokes in either cohort and two major adverse bleeding events as a result of recommended pharmacologic antithrombosis. Non-selective screening is not warranted and should be limited to a high-risk subset of patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.