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  • Title: Incidence of blunt cerebrovascular injury in low-risk cervical spine fractures.
    Author: Kopelman TR, Leeds S, Berardoni NE, O'Neill PJ, Hedayati P, Vail SJ, Pieri PG, Feiz-Erfan I, Singer Pressman MA.
    Journal: Am J Surg; 2011 Dec; 202(6):684-8; discussion 688-9. PubMed ID: 22137135.
    Abstract:
    BACKGROUND: It has been suggested that specific cervical spine fractures (CSfx) (location at upper cervical spine [CS], subluxation, or involvement of the transverse foramen) are predictive of blunt cerebrovascular injury (BCVI). We sought to determine the incidence of BCVI with CSfx in the absence of high-risk injury patterns. METHODS: We performed a retrospective study in patients with CSfx who underwent evaluation for BCVI. The presence of recognized CS risk factors for BCVI and other risk factors (Glasgow coma score ≤ 8, skull-based fracture, complex facial fractures, soft-tissue neck injury) were reviewed. Patients were divided into 2 groups based on the presence/absence of risk factors. RESULTS: A total of 260 patients had CSfx. When screened for high-risk pattern of injury for BCVI, 168 patients were identified and 13 had a BCVI (8%). The remaining 92 patients had isolated low CSfx (C4-C7) without other risk factors for BCVI. In this group, 2 patients were diagnosed with BCVI (2%). Failure to screen all patients with CSfx would have missed 2 of 15 BCVIs (13%). CONCLUSIONS: We propose that all CS fracture patterns warrant screening for BCVI.
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