title: Clinical indications for arterial imaging in cervical trauma.
abstract: METHODS
  A retrospective cohort study.
  
  
  OBJECTIVE
  To evaluate the clinical indications for acquiring arterial imaging in cervical trauma.
  
  
  BACKGROUND
  Cervical spine injuries are very common in high-energy trauma and are frequently seen at Level I trauma centers across the country. A clinical standard of care does not exist to indicate when further evaluation of the cervical vasculature is warranted after a documented cervical spine injury.
  
  
  METHODS
  After institutional review board approval, a retrospective study combining the data from 2 Level I trauma centers was undertaken. An evaluation of every arterial imaging procedure (computed tomography and magnetic resonance angiography) of the cervical spine was collected to further delineate indications and outcomes of these imaging modalities.
  
  
  RESULTS
  From 2005 to 2009, there were a total of 159 patients who underwent cervical arterial imaging at the 2 participating institutions for the indication of cervical trauma with concern for arterial injury. Thirty-six (22.64%) were found to have an injury after arterial imaging. There was a statistically significant correlation with displaced cervical injuries (P < 0.0153), which were defined as cervical dissociations or perched and/or jumped facets. The other statistically significant correlation was the presence of a neurological deficit (P < 0.001), defined as any presenting deficit on sensory or motor examination. Level of injury defined as axial (O-C2) versus subaxial (C3-C7), age, body mass index, and history of cigarette smoking were not statistically related to vascular injury.
  
  
  CONCLUSIONS
  Our retrospective evaluation indicates that there should be a lower threshold for obtaining arterial imaging with cervical injury patterns historically known to compromise the vasculature, which also have concomitant displaced cervical spine injuries and/or a neurological deficit.
authors.affiliation: Vanderbilt University Medical Center, 1215 21st Avenue, Nashville, TN 37232, USA. Jesse.Even@Vanderbilt.edu
authors.forename: Jesse
authors.initials: J
authors.lastname: Even
authors.forename: Kirk
authors.initials: K
authors.lastname: McCullough
authors.forename: Brett
authors.initials: B
authors.lastname: Braly
authors.forename: Justin
authors.initials: J
authors.lastname: Hohl
authors.forename: Yanna
authors.initials: Y
authors.lastname: Song
authors.forename: Joon
authors.initials: J
authors.lastname: Lee
authors.forename: Matthew
authors.initials: M
authors.lastname: McGirt
authors.forename: Clinton
authors.initials: C
authors.lastname: Devin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000293:injuries / Q000473:pathology; D002574:Cervical Vertebrae / Q000098:blood supply*; D005260:Female; D006801:Humans; D004204:Joint Dislocations; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases; D018579:Patient Selection; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D057772:Vascular System Injuries / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult