Is Vertebral Artery Injury After Blunt Cervical Spine Trauma an Incidental Finding?

Study Design: Retrospective cohort study. Objectives: To understand the associations between vertebral artery injury (VAI) and adverse events in patients sustaining blunt cervical spine trauma. Summary of Background Data: To date, the impact of VAI on adverse events, and by extension, clinical outcomes has been extracted from small patient cohorts and have not allowed definitive conclusions. Methods: Adult patients with cervical vertebral, ligamentous, or neurological trauma in the National Trauma Data Bank from 2016 to 2017 were included in the study. Demographic information (age, sex, and race), injury-specific information (mechanism, severity), patient health information, and presence of a VAI were collected as explanatory variables. Response variables included development of adverse events [DVT/PE, myocardial infarction (MI), stroke, hemorrhage, or neurological deficit] length of stay (LOS) and unplanned ICU admission or surgical procedure. Multivariable regression was used to calculate the risk-adjusted effect of vertebral artery injury on the presence of adverse and unplanned events as well as its relationship with LOS. Results: Totally, 128,908 patients with cervical trauma were reviewed, of which 5300 had VAI. Of the patients with VAI, 187 (3.5%) patients had a MI, 156 (2.9%) had a PE/DVT, 196 (3.7%) had a stroke, 1392 (26.3%) had neurological injury, and 443 (8.4%) had an unplanned operative procedure or ICU admission. After risk-adjustment, VAI was associated with a >2-fold increased risk of increased LOS and ICU LOS ( P <0.001), as well as greater than a 2-fold increased risk of MI, PE/DVT, stroke, and neurological injury ( P <0.001). Conclusions: Our study documented a higher rate of concomitant VAI in blunt cervical trauma than previously reported. VAI is a hallmark of a more severe or higher energy mechanism of injury and is associated with increased adverse events and LOS in the hospital/ICU. In addition, these data suggest that, in older patients, concomitant VAI is associated with adverse outcomes independent of mechanism of injury. Level of Evidence: Step II—diagnostic study.