Shifting Perspectives: Equal Blunt Cerebrovascular Risk in Low- vs. High-Energy Cervical Fracture

David A Turaczyk Kolodziej; Michael Lung; Michele Lilienthal; Colette Galet; Vishnu Mani; Dionne Skeete

doi:10.1016/j.jss.2024.04.058

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Shifting Perspectives: Equal Blunt Cerebrovascular Risk in Low- vs. High-Energy Cervical Fracture

Journal article

Peer reviewed

Shifting Perspectives: Equal Blunt Cerebrovascular Risk in Low- vs. High-Energy Cervical Fracture

David A Turaczyk Kolodziej, Michael Lung, Michele Lilienthal, Colette Galet, Vishnu Mani and Dionne Skeete

The Journal of surgical research, Vol.300, pp.63-70

08/2024

DOI: 10.1016/j.jss.2024.04.058

PMCID: PMC11246807

PMID: 38795674

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https://pmc.ncbi.nlm.nih.gov/articles/PMC11246807/pdf/nihms-1991323.pdfView

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Abstract

Introduction Clinical implications of screening for blunt cerebrovascular injury (BCVI) after low-energy mechanisms of injury (LEMI) remain unclear. We assessed BCVI incidence and outcomes in LEMI versus high-energy mechanisms of injury (HEMI) patients. Methods In this retrospective cohort study, blunt trauma adults admitted between July 2015 and June 2021 with cervical spine fractures, excluding single spinous process, osteophyte, and chronic fractures were included. Demographics, comorbidities, injuries, screening and treatment data, iatrogenic complications, and mortality were collected. Our primary end point was to compare BCVI rates between LEMI and HEMI patients. Results Eight hundred sixty patients (78%) were screened for BCVI; 120 were positive for BCVI. LEMI and HEMI groups presented similar BCVI rates (12.6% versus 14.4%; P = 0.640). Compared to HEMI patients (n = 95), LEMI patients (n = 25) were significantly older (79 ± 14.9 versus 54.3 ± 17.4, P < 0.001), more likely to be on anticoagulants before admission (64% versus 23.2%, P < 0.001), and less severely injured (LEMI injury severity score 10.9 ± 6.6 versus HEMI injury severity score 18.7 ± 11.4, P = 0.001). All but one LEMI and 90.5% of the HEMI patients had vertebral artery injuries with no significant difference in BCVI grades. One HEMI patient developed acute kidney injury because of BCVI screening. Eleven HEMI patients developed BCVI-related stroke with two related mortalities. One LEMI patient died of a BCVI-related stroke. Conclusions BCVI rates were similar between HEMI and LEMI groups when screening based on cervical spine fractures. The LEMI group exhibited no screening or treatment complications, suggesting that benefits may outweigh the risks of screening and potential bleeding complications from treatment.

Antithrombotic

Blunt cerebrovascular injury

Cervical spine fracture

Low-energy mechanism of injury

Outcomes

Screening

Details

Title: Subtitle: Shifting Perspectives: Equal Blunt Cerebrovascular Risk in Low- vs. High-Energy Cervical Fracture
Creators: David A Turaczyk Kolodziej - University of Iowa, Surgery
Michael Lung - University of Iowa
Michele Lilienthal - University of Iowa
Colette Galet - University of Iowa
Vishnu Mani - University of Iowa
Dionne Skeete - University of Iowa
Resource Type: Journal article
Publication Details: The Journal of surgical research, Vol.300, pp.63-70
DOI: 10.1016/j.jss.2024.04.058
PMID: 38795674
PMCID: PMC11246807
NLM abbreviation: J Surg Res
ISSN: 0022-4804
eISSN: 1095-8673
Publisher: Elsevier
Grant note: National Center For Advancing Translational Sciences of the National Institutes of Health: UM1TR004403
Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UM1TR004403. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Language: English
Electronic publication date: 05/24/2024
Date published: 08/2024
Academic Unit: Surgery; Injury Prevention Research Center; University of Iowa Health Care
Record Identifier: 9984927213002771

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