157 The Effectiveness of Computed Tomographic Angiography on Cervical Spine Fracture Outcomes

INTRODUCTION: Patients with cervical spine fracture are at risk for vertebral artery injury (VAI). No standard currently exists for the use of computed tomographic angiography (CTA) in the evaluation of such injury, although recent studies suggest that more selective criteria (“high-risk” fracture patterns) may be adopted. We sought to determine the incidence of VAI among patients with cervical spine fracture screened with CTA. We further sought to assess the association between both risk stratification and VAI on stroke. METHODS: This retrospective chart review included all consecutive patients that presented to our level I trauma center with cervical spine fracture from January 2002 to December 2012. Fracture type, fracture level, VAI screening modality, VAI diagnosis/grade, stroke incidence, patient demographics, and CTA results were reviewed for each patient. RESULTS: Sample consisted of 1547 patients, 706 were considered high-risk, and 745 received CTA. Patients who were high-risk had 4.2 the odds of receiving a CTA compared to low risk patients (95% confidence interval, 3.4-5.2). A total of 77 patients in our total sample had stroke, of which only 55% met the criteria for high-risk fracture and 43 (56%) underwent CTA. Interestingly, of the 43 patients who had stroke and underwent CTA, only 35% were found to have VAI on CTA. Neither high-risk fracture nor undergoing CTA was associated with increased odds for stroke in our sample. CONCLUSION: We did not find any association between risk stratification previously proposed in the literature and stroke among patients with cervical spine fracture. While VAI was associated with high-risk fracture types, it was not associated with increased stroke rate. In our study, the use of CTA did not have an impact on stroke rate, therefore casting doubt on the benefit of using CTA as a screening method for VAI, and thus stroke, at our institution.