title: Blunt Cerebrovascular Injury in Cervical Spine Fractures: Are More-Liberal Screening Criteria Warranted?
abstract: Study DesignRetrospective comparative study.ObjectiveTo compare strict Biffl criteria to more-liberal criteria for computed tomography angiography (CTA) when screening for blunt cerebrovascular injury (BCVI).MethodsAll CTAs performed for blunt injury between 2009 and 2011 at our institution were reviewed. All patients with cervical spine fractures who were evaluated with CTA were included; patients with penetrating trauma and atraumatic reasons for imaging were excluded. We then categorized the patients' fractures based on the indications for CTA as either within or outside Biffl criteria. For included subjects, the percentage of studies ordered for loose versus strict Biffl criteria and the resulting incidences of BCVI were determined.ResultsDuring our study period, 1,000 CTAs were performed, of which 251 met inclusion criteria. Of the injuries, 192 met Biffl criteria (76%). Forty-nine were found to have BCVIs (19.5%). Forty-one injuries were related to fractures meeting Biffl criteria (21.4%), and 8 were related to fractures not meeting those criteria (13.6%). The relative risk of a patient with a Biffl criteria cervical spine injury having a vascular injury compared with those imaged outside of Biffl criteria was 1.57 (p= 0.19).ConclusionsOur data demonstrates that although cervical spine injuries identified by the Biffl criteria trend toward a higher likelihood of concomitant BCVI (21.4%), a significant incidence of 13.6% also exists within the non-Biffl fracture cohort. As a result, a more-liberal screening than proposed by Biffl may be warranted.
authors: Department of Orthopaedic Surgery, University of South Carolina, Columbia, South Carolina, United States.
authors: Gregory
authors: G
authors: Grabowski
authors: Department of Orthopaedic Surgery, University of South Carolina, Columbia, South Carolina, United States.
authors: Ryan N
authors: RN
authors: Robertson
authors: Department of Orthopaedic Surgery, University of South Carolina, New Orleans, Louisiana, United States.
authors: Blair M
authors: BM
authors: Barton
authors: Department of Orthopaedic Surgery, University of South Carolina, Durham, North Carolina, United States.
authors: Mark A
authors: MA
authors: Cairns
authors: Department of Neurosurgery, Greenville Health System, Greenville, South Carolina, United States.
authors: Sharon W
authors: SW
authors: Webb
keywords: Biffl criteria; blunt cerebrovascular injury; blunt trauma; cervical injury; cervical spine trauma; vertebral artery injury