Cervical angiograms in cervical spine trauma patients 5 years after the data: has practice changed?

Kelsey A. Rebehn, Howard M. Place


Background: We sought to retrospectively evaluate changes in practice of use of computed tomography angiography (CTA) in the cervical spine trauma population at the authors’ institution following intervention to increase the clinical utility of this study. Prior studies have shown screening asymptomatic trauma patients demonstrate a rate of vertebral artery injury (VAI) near 1%. While CTA can readily provide a diagnosis, the high number of concomitant injuries limit which patients are candidates for treatment. At our institution, this had been described in a previous 5-year study.
Methods: After IRB approval, 1,201 charts from 2011 to 2016 were reviewed at our Level 1 trauma hospital. Data collected included cervical injury type, neurologic examination, diagnostic testing, and treatments or complications of VAI. This time frame begins after the prior study was completed and results of the study had been disseminated among the trauma faculty.
Results: A total of 1,142 subjects were eligible for inclusion. Six hundred forty patients had cervical spine fractures, and of these 158 patients had CTA/MRA. Twenty-four were diagnosed with VAI, and 12 were treated. None of the subjects had complications from angiography, one patient with VAI had blood loss after initiation of therapeutic anticoagulation requiring transfusion. There has been a significant increase in CTA/MRA testing (P<0.001), but no significant increase in patients treated or in percent of positive tests (P=0.15, P=0.77).
Conclusions: Despite discussion at our institution of the clinical utility of CTA in the trauma population, there are more CTA studies being done and without a corresponding change in rate of diagnosis or treatment for VAI. The presence of symptoms and risk of therapeutic anticoagulation in this population are important factors to consider. We recommend the use of a treatment algorithm in the electronic ordering system to help aid practitioners in targeting the use of this test.