Does improved detection of blunt vertebral artery injuries lead to improved outcomes? Analysis of the National Trauma Data Bank.
BACKGROUND
The rate of blunt vertebral artery (BVI) has increased in institutions using aggressive screening protocols. It is unclear whether earlier diagnosis and therapy have improved outcomes. Our goal was to estimate the national incidence of BVI and BVI-related stroke (BVI-S), and report on the functional outcome of patients with this diagnosis.


METHODS
The annual rates of BVI and BVI-S were estimated by using the National Trauma Data Bank (NTDB) from 2001 to 2005. The functional outcome was evaluated by the modified functional independence measure (FIM) score (range, 3-12).


RESULTS
A total of 574 patients with BVI were identified among the 761,385 blunt trauma admissions (0.075% overall incidence). BVI-S was diagnosed in 12% of patients with BVI and no associated blunt carotid injury. The FIM on discharge was 9.62 +/- 2.78 (range, 3-12), and 49% of the patients showed complete functional independence. Overall mortality was 8%. The annual incidence showed a steady increase from 0.053% in 2001 to 0.1% in 2005 (p < 0.001). No difference in annual BVI-S and complete functional independence was observed.


CONCLUSIONS
As a result of increased awareness, the nation-wide rate of detection of BVI has doubled in recent years. However, BVI-S rates and functional outcome have not improved, raising questions about the available treatment protocols.
Spaniolas
Konstantinos
K
Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Boston, MA 02114, USA.
Velmahos
George C
GC
Alam
Hasan B
HB
de Moya
Marc
M
Tabbara
Malek
M
Sailhamer
Elizabeth
E
D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014711:Vertebral Artery / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality