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Traumatic vertebral artery injury: proposal for classification of the severity of trauma and likelihood of fatal outcome

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Abstract

Vertebral artery injury (VAI) occurs after (blunt) trauma as well as spontaneously. The risk of incurring VAI from a blunt trauma probably parallels the severity of trauma, often referred to as major- and minor-trauma. However, the literature does not provide concrete definitions of these terms. This study aims to define minor- and major-trauma and to analyze the likelihood of fatal outcome in VAI. For this purpose, classification criteria of major- and minor-trauma were developed and a PubMed database search was performed for articles on VAI published prior to 2013. The definitions of minor- and major-trauma, derived mainly from radiological screening criteria in cervical spine injury and based on the mechanism leading to the injury, were used in the analysis of the literature. The search produced 241 VAI cases with sufficiently detailed data for the comparison of major-trauma (52 cases, 50 lethal), minor-trauma (8 cases, none lethal), and no-trauma (182 cases, 69 lethal). The numbers of lethal cases in the total study population and subgroups differed significantly between the groups (Fisher’s exact test) and the likelihood ratios (LRs) of lethal outcome were substantially higher in the major-trauma group compared to the other groups. The highly significant p values show that the proposed criteria differentiate between trauma types with regard to fatal outcome. The presented results can assist in the evaluation of forensic cases of VAI.

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Abbreviations

CCR:

Canadian C-Spine Rule

LR:

Likelihood ratio

MVC:

Motor vehicle collision

PM:

Post-mortem

VAI:

Vertebral artery injury

SAH:

Subarachnoid hemorrhage

TVAI:

Blunt force traumatic vertebral artery injury

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Forensic Medicine, Netherlands Forensic Institute, Laan van Ypenburg 6, 2497 GB, The Hague, The Netherlands

    Bela B. Kubat & Marijke M. Buiskool

  2. Department of Pathology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, ‘s-Hertogenbosch, The Netherlands

    Robert-Jan van Suylen

Authors
  1. Bela B. Kubat
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  2. Marijke M. Buiskool
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  3. Robert-Jan van Suylen
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Correspondence to Bela B. Kubat.

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Kubat, B.B., Buiskool, M.M. & van Suylen, RJ. Traumatic vertebral artery injury: proposal for classification of the severity of trauma and likelihood of fatal outcome. Int J Legal Med 129, 141–148 (2015). https://doi.org/10.1007/s00414-014-1095-9

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  • DOI: https://doi.org/10.1007/s00414-014-1095-9

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