BETWEEN MEMPHIS AND DENVER: MIDWEST PREDICTORS OF BLUNT CEREBROVASCULAR INJURY
*Jared C Sheppard, *Amanda E Chelednik, Jacob A Quick, Stephen L Barnes
University of Missouri, Columbia, MO
OBJECTIVE(S): Blunt cerebrovascular injury (BCVI) may result in significant morbidity and mortality if not identified early. Memphis and Denver screening criteria for BCVI exist, but the literature varies as to the efficacy of each. We aimed to examine predictive factors suggestive of BCVI.
METHODS: 815 consecutive blunt trauma patients who underwent a screening CTA of the head or neck during their index admission between 2012 and 2018 were retrospectively analyzed. Data corresponding to published screening criteria for BCVI were collected. Those with confirmed BCVI were compared to those with negative findings and analyzed.
RESULTS: Of the 815 patients who underwent CTA, 114 (14.0%) had findings consistent with BCVI. 63 (7.7%) of these patients were confirmed to have BCVI. Mean injury severity scores were higher in those with BCVI (19.5 vs. 25.5, p 0.0004). There were no differences between the two groups in regards to physical exam findings, including GCS, cervical spine tenderness, scalp de-gloving injuries, hematomas, or soft tissue injuries. More cervical spine injuries were present in those with BCVI, including spinal cord injuries (2.8% vs. 7.9%, p 0.026), cervical subluxation (2.4% vs. 17.5%, p <0.0001), C1-C3 fractures (10.0% vs. 20.6%, p 0.009) and transverse foramen fractures (6.8% vs. 28.6%, p <0.0001). There was no difference in the rate of intracranial hemorrhage, diffuse axonal injury, Le Forte fractures, or basilar skull fractures between the groups. Regression analysis identified cervical spine fracture (OR 4.62, p 0.0005), and specifically transverse foramen fractures (OR 5.50, p 0.034) and subluxation (OR 8.63, p 0.006) as the only radiographic findings predictive of BCVI (Table 1).
CONCLUSIONS: Cervical spine fractures are most predictive of BCVI. Protocols allowing early determination of fractures should be instituted, so that targeted screening may be performed during the initial evaluation.
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