title: Incidence of blunt cerebrovascular injury in low-risk cervical spine fractures.
abstract: BACKGROUND
  It has been suggested that specific cervical spine fractures (CSfx) (location at upper cervical spine [CS], subluxation, or involvement of the transverse foramen) are predictive of blunt cerebrovascular injury (BCVI). We sought to determine the incidence of BCVI with CSfx in the absence of high-risk injury patterns.
  
  
  METHODS
  We performed a retrospective study in patients with CSfx who underwent evaluation for BCVI. The presence of recognized CS risk factors for BCVI and other risk factors (Glasgow coma score ≤ 8, skull-based fracture, complex facial fractures, soft-tissue neck injury) were reviewed. Patients were divided into 2 groups based on the presence/absence of risk factors.
  
  
  RESULTS
  A total of 260 patients had CSfx. When screened for high-risk pattern of injury for BCVI, 168 patients were identified and 13 had a BCVI (8%). The remaining 92 patients had isolated low CSfx (C4-C7) without other risk factors for BCVI. In this group, 2 patients were diagnosed with BCVI (2%). Failure to screen all patients with CSfx would have missed 2 of 15 BCVIs (13%).
  
  
  CONCLUSIONS
  We propose that all CS fracture patterns warrant screening for BCVI.
authors.affiliation: Division of Burns, Trauma, and Surgical Critical Care, Maricopa Medical Center, Phoenix, AZ 85008, USA. Tammy_Kopelman@dmgaz.org
authors.forename: Tammy R
authors.initials: TR
authors.lastname: Kopelman
authors.forename: Steven
authors.initials: S
authors.lastname: Leeds
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Berardoni
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Neill
authors.forename: Poya
authors.initials: P
authors.lastname: Hedayati
authors.forename: Sydney J
authors.initials: SJ
authors.lastname: Vail
authors.forename: Paola G
authors.initials: PG
authors.lastname: Pieri
authors.forename: Iman
authors.initials: I
authors.lastname: Feiz-Erfan
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Singer Pressman
mesh_terms: D000293:Adolescent; D000328:Adult; D002533:Cerebral Angiography; D020214:Cerebrovascular Trauma / Q000175:diagnosis / Q000453:epidemiology*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009104:Multiple Trauma; D011379:Prognosis; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis* / Q000453:epidemiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult