Wednesday, September 26, 2018 10:35 AM – 12:00 PM Cervical Spine Trauma: 24. Cervical angiograms in cervical spine trauma patients five years after the data: has practice changed?

BACKGROUND CONTEXT Advanced diagnostic imaging utilizing CT technology has made angiography easier and faster to obtain in the trauma setting. Prior studies have shown that the rates of symptomatic vertebral artery injuries (VAI) are relatively low in the trauma population, approximately 0.1%, but that screening a broader population of asymptomatic trauma patients can increase the rate of injuries diagnosed to near 1%2. While CT angiography (CTA) can readily provide a diagnosis, clinical significance of a positive result in polytrauma patients is limited by the high number of concomitant injuries and limit the number of patients who are candidates for therapeutic anticoagulation or other treatments. PURPOSE At our institution, this had been described in a previous five-year study and the information disseminated between trauma attending physicians and the orthopedic department. We sought to retrospectively evaluate the patterns use of CTA in the trauma population at the authors’ institution for the five years after this intervention was taken to evaluate for changes in practice. STUDY DESIGN/SETTING Retrospective observational study at a Level 1 trauma hospital. PATIENT SAMPLE A total of 1,201 charts from 2011 to 2016 were reviewed including all level 1 and 2 trauma patients with cervical spine complaints and 1,142 subjects were eligible for inclusion. This time frame begins after the prior referenced study by Dreger et al was completed and results of the study had been disseminated among the trauma and orthopedic faculty OUTCOME MEASURES Outcome measures were positive CTA study, and treatment for diagnosed vertebral artery injury. METHODS A total of 1,201 charts were reviewed. A total of 1,142 subjects were eligible for inclusion, and 187 subjects underwent CTA/MRA. A total of 640 patients had cervical spine fractures, and of these 158 patients had CTA/MRA. Inclusion criteria were ages 18-89, and imaging of the cervical spine performed. Exclusion criteria were ballistic or penetrating trauma to the neck, death on arrival to the emergency department without imaging performed, and imaging performed at outside institution only. Statistical analysis was performed using SPSS. RESULTS Twenty-four patients were diagnosed with VAI, and 12 were treated for these findings. None of the subjects treated had complications from angiography, one patient with VAI had increased blood loss after initiation of therapeutic anticoagulation requiring transfusion. There has been a significant increase in CTA/MRA testing done at our institution (P CONCLUSIONS Despite discussion at our institution of the clinical utility of CTA in the trauma population, there are more CTA studies being done and the number of patient's diagnosed and treated for VAI have not changed. The presence of symptoms and risk of bleeding or other complications of therapeutic anticoagulation in this population are important factors to consider when ordering this test. We recommend the use of a treatment algorithm in the electronic ordering system to help aid practitioners in targeting the use of this test. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.