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Cervical Spine Fractures: Who Really Needs CT Angiography?
Mitchell S Fourman1, Jeremy D Shaw1, Nicholas J Vaudreuil1
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Spine
|July 27, 2019
Summary
A new two-step algorithm for computed tomography angiography (CTA) screening in cervical spine fracture patients can reduce unnecessary scans by 63% while maintaining diagnostic accuracy for blunt cerebrovascular injuries (BCVI) and strokes.
Area of Science:
- Trauma Surgery
- Vascular Imaging
- Neurology
Background:
- Computed tomography angiography (CTA) is crucial for detecting blunt cerebrovascular injuries (BCVI) following cervical spine fractures.
- Broadened screening criteria for CTA may lead to overdiagnosis of BCVI.
- Efficient and accurate screening is essential to balance detection rates and resource utilization.
Purpose of the Study:
- To compare a novel two-step algorithm for CTA screening with existing criteria (American College of Surgeons and Denver Criteria) in patients with cervical spine fractures.
- To evaluate the diagnostic performance of the novel algorithm in identifying BCVI and posterior circulation strokes.
- To assess the potential reduction in CTA utilization with the proposed algorithm.
Main Methods:
- Retrospective cohort study of 721 patients with cervical spine fractures.
- Comparison of a novel two-step screening metric against the American College of Surgeons and expanded Denver Criteria.
- Assessment of the ability of each metric to identify BCVI and posterior circulation strokes.
Main Results:
- The novel algorithm identified a similar number of BCVIs (52) and strokes (7/7) compared to established criteria (ACS: 54 BCVIs, 6/7 strokes; Denver: 54 BCVIs, 6/7 strokes).
- The novel two-step algorithm could reduce the number of CTAs performed by 63% (36.2% of patients) compared to ACS (57.3%) and Denver Criteria (57.8%).
- Statistical analysis showed no significant difference in BCVI detection (P = 0.84) and a trend towards better stroke detection with the novel metric (P = 1.0).
Conclusions:
- A two-step criterion, incorporating mechanism of injury and patient factors, shows promise for guiding CTA screening in patients with cervical spine fractures.
- This novel approach may significantly decrease unnecessary CTA scans without compromising the detection of critical vascular injuries and strokes.
- Further prospective studies are recommended before widespread clinical implementation.
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