title: Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center.
abstract: OBJECTIVE
  Screening for vertebral artery injury (VAI) following cervical spine fractures is routinely performed across trauma centers in North America. From 2002 to 2007, the total number of neck CT angiography (CTA) studies performed in the Medicare population after trauma increased from 9796 to 115,021. In the era of cost-effective medical care, the authors aimed to evaluate the utility of CTA screening in detecting VAI and reduce chances of posterior circulation strokes after traumatic cervical spine fractures.
  
  
  METHODS
  A retrospective review of all patients presenting with cervical spine fractures to Northeast Ohio's Level I trauma institution from 2002 to 2012 was performed.
  
  
  RESULTS
  There was a total of 1717 cervical spine fractures in patients presenting to Northeast Ohio's Level I trauma institution between 2002 and 2012. CTA screening was performed in 732 patients, and 51 patients (0.7%) were found to have a VAI. Fracture patterns with increased odds of VAI were C-1 and C-2 combined fractures, transverse foramen fractures, and subluxation of adjacent vertebral levels. Ten posterior circulation strokes were identified in this patient population (0.6%) and found in only 4 of 51 cases of VAI (7.8%). High-risk fractures defined by Denver Criteria, VAI, and antiplatelet treatment of VAI were not independent predictors of stroke.
  
  
  CONCLUSIONS
  Cost-effective screening must be reevaluated in the setting of blunt cervical spine fractures on a case-by-case basis. Further prospective studies must be performed to elucidate the utility of screening for VAI and posterior circulation stroke prevention, if identified.
authors.affiliation: Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center;
authors.forename: Megan M
authors.initials: MM
authors.lastname: Lockwood
authors.affiliation: Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center;
authors.forename: Gabriel A
authors.initials: GA
authors.lastname: Smith
authors.affiliation: Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center;
authors.forename: Joseph
authors.initials: J
authors.lastname: Tanenbaum
authors.affiliation: Cleveland Clinic Lerner College of Medicine; and.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.affiliation: Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center;
authors.forename: Andreea
authors.initials: A
authors.lastname: Seicean
authors.affiliation: Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center;
authors.forename: Jonathan
authors.initials: J
authors.lastname: Pace
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland, Ohio.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland, Ohio.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland, Ohio.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
mesh_terms: D000792:Angiography / Q000379:methods*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014193:Trauma Centers; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries*
keywords: BCVI = blunt cerebrovascular injury; CT angiography; CTA = CT angiography; VAI = vertebral artery injury; cervical spine fracture; trauma; vertebral artery injury