Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Division of Trauma Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Spine (Phila Pa 1976). 2019 Dec 1;44(23):1661-1667. doi: 10.1097/BRS.0000000000003163.
Retrospective cohort study.
Compare a novel two-step algorithm for indicating a computed tomography angiography (CTA) in the setting of a cervical spine fracture with established gold standard criteria.
As CTA permits the rapid detection of blunt cerebrovascular injuries (BCVI), screening criteria for its use have broadened. However, more recent work warns of the potential for the overdiagnosis of BCVI, which must be considered with the adoption of broad criteria.
A novel two-step metric for indicating CTA screening was compared with the American College of Surgeons guidelines and the expanded Denver Criteria using patients who presented with cervical spine fractures to a tertiary-level 1 trauma center from January 1, 2012 to January 1, 2016. The ability for each metric to identify BCVI and posterior circulation strokes that occurred during this period was assessed.
A total of 721 patients with cervical fractures were included, of whom 417 underwent CTAs (57.8%). Sixty-eight BCVIs and seven strokes were diagnosed in this cohort. All algorithms detected an equivalent number of BCVIs (52 with the novel metric, 54 with the ACS and Denver Criteria, P = 0.84) and strokes (7/7, 100% with the novel metric, 6/7, 85.7% with the ACS and Denver Criteria, P = 1.0). However, 63% fewer scans would have been needed with the proposed screening algorithm compared with the ACS or Denver Criteria (261/721, 36.2% of all patients with our criteria vs. 413/721, 57.3% with the ACS standard and 417/721, 57.8%) with the Denver Criteria, P < 0.0002 for each).
A two-step criterion based on mechanism of injury and patient factors is a potentially useful guide for identifying patients at risk of BCVI and stroke after cervical spine fractures. Further prospective analyses are required prior to widespread clinical adoption.
回顾性队列研究。
比较一种新的两步算法，用于指示颈椎骨折患者进行计算机断层血管造影（CTA），并与既定的金标准标准进行比较。
由于 CTA 允许快速检测钝性脑血管损伤（BCVI），因此其使用的筛选标准已经扩大。然而，最近的研究警告称，BCVI 的过度诊断的可能性增加，这必须在采用广泛的标准时加以考虑。
使用从 2012 年 1 月 1 日至 2016 年 1 月 1 日在三级 1 级创伤中心就诊的颈椎骨折患者，比较了一种新的两步指标，用于指示 CTA 筛查，并与美国外科医师学院指南和扩展的丹佛标准进行比较。评估每个指标识别在此期间发生的 BCVI 和后循环中风的能力。
共纳入 721 例颈椎骨折患者，其中 417 例行 CTA（57.8%）。在此队列中诊断出 68 例 BCVI 和 7 例中风。所有算法均检测到相同数量的 BCVI（新型指标 52 例，ACS 和丹佛标准 54 例，P=0.84）和中风（新型指标 7/7，100%，ACS 和丹佛标准 6/7，85.7%，P=1.0）。然而，与 ACS 或丹佛标准相比，新提出的筛选算法所需的扫描量减少了 63%（新型标准 261/721，所有患者的 36.2%，ACS 标准 413/721，57.3%，丹佛标准 417/721，57.8%，P<0.0002）。
基于损伤机制和患者因素的两步标准是识别颈椎骨折后发生 BCVI 和中风风险患者的一种潜在有用的指南。在广泛临床应用之前，需要进行进一步的前瞻性分析。
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