World Journal of Surgery

, 32:2190

Does Improved Detection of Blunt Vertebral Artery Injuries Lead to Improved Outcomes? Analysis of the National Trauma Data Bank®

  • Konstantinos Spaniolas
  • George C. Velmahos
  • Hasan B. Alam
  • Marc de Moya
  • Malek Tabbara
  • Elizabeth Sailhamer



The rate of blunt vertebral artery (BVI) has increased in institutions using aggressive screening protocols. It is unclear whether earlier diagnosis and therapy have improved outcomes. Our goal was to estimate the national incidence of BVI and BVI-related stroke (BVI-S), and report on the functional outcome of patients with this diagnosis.


The annual rates of BVI and BVI-S were estimated by using the National Trauma Data Bank (NTDB®) from 2001 to 2005. The functional outcome was evaluated by the modified functional independence measure (FIM) score (range, 3–12).


A total of 574 patients with BVI were identified among the 761,385 blunt trauma admissions (0.075% overall incidence). BVI-S was diagnosed in 12% of patients with BVI and no associated blunt carotid injury. The FIM on discharge was 9.62 ± 2.78 (range, 3–12), and 49% of the patients showed complete functional independence. Overall mortality was 8%. The annual incidence showed a steady increase from 0.053% in 2001 to 0.1% in 2005 (p < 0.001). No difference in annual BVI-S and complete functional independence was observed.


As a result of increased awareness, the nation-wide rate of detection of BVI has doubled in recent years. However, BVI-S rates and functional outcome have not improved, raising questions about the available treatment protocols.


  1. 1.
    Cothren CC, Moore EE, Ray CE, Ciesla DJ, Johnson JL, Moore JB, Burch JM (2005) Screening for blunt cerebrovascular injuries is cost-effective. Am J Surg 190:845–849PubMedGoogle Scholar
  2. 2.
    Miller PR, Fabian TC, Croce MA, Cagiannos C, Williams JS, Vang M et al (2002) Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg 236:386–393PubMedCrossRefGoogle Scholar
  3. 3.
    Miller PR, Fabian TC, Bee TK, Timmons S, Chamsuddin A, Finkle R, Croce MA (2001) Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma 51:279–285PubMedGoogle Scholar
  4. 4.
    Biffl WL, Moore EE, Elliott JP, Ray C, Offner PJ, Franciose RJ et al (2000) The devastating potential of blunt vertebral arterial injuries. Ann Surg 231:672–681PubMedCrossRefGoogle Scholar
  5. 5.
    Biffl WL, Ray CE, Moore EE, Franciose RJ, Aly S, Heyrosa MG et al (2002) Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg 235:699–706PubMedCrossRefGoogle Scholar
  6. 6.
    McKevitt EC, Kirkpatrick AW, Vertesi L, Granger R, Simons RK (2002) Blunt vascular neck injuries: diagnosis and outcomes of extracranial vessel injury. J Trauma 53:472–476PubMedGoogle Scholar
  7. 7.
    Kerwin AJ, Bynoe RP, Murray J, Hudson ER, Close TP, Gifford RR et al (2001) Liberalized screening for blunt carotid and vertebral artery injuries is justified. J Trauma 51:308–314PubMedGoogle Scholar
  8. 8.
    Berne JD, Norwood SH, McAuley CE, Vallina VL, Creath RG, McLarty J (2001) The high morbidity of blunt cerebrovascular injury in an unscreened population: more evidence of the need for mandatory screening protocols. J Am Coll Surg 192:314–321PubMedCrossRefGoogle Scholar
  9. 9.
    Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC (1996) The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil 77:1226–1232PubMedCrossRefGoogle Scholar
  10. 10.
    Fletcher R, Woodward J, Royle J, Buxton B (1974) Cerebral embolism following blunt extracranial vascular trauma: a report of two cases. Aust N Z J Surg 44:269–272PubMedCrossRefGoogle Scholar
  11. 11.
    Hayes P, Gerlock AJ, Cobb CA (1980) Cervical spine trauma: a cause of vertebral artery injury. J Trauma 20:904–905PubMedGoogle Scholar
  12. 12.
    Dragon R, Saranchak H, Lakin P, Strauch G (1981) Blunt injuries to the carotid and vertebral arteries. Am J Surg 141:497–500PubMedCrossRefGoogle Scholar
  13. 13.
    Torina PJ, Flanders AE, Carrino JA, Burns AS, Friedman DP, Harrop JS, Vacarro AR (2005) Incidence of vertebral artery thrombosis in cervical spine trauma: correlation with severity of spinal cord injury. AJNR Am J Neuroradiol 26:2645–2651PubMedGoogle Scholar
  14. 14.
    Cothren CC, Moore EE, Biffl WL, Ciesla DJ, Ray CE, Johnson JL et al (2003) Cervical spine fracture patterns predictive of blunt vertebral artery injury. J Trauma 55:811–813PubMedGoogle Scholar
  15. 15.
    Eastman AL, Chason DP, Perez CL, McAnulty AL, Minei JP (2006) Computed tomographic angiography for the diagnosis of blunt cervical vascular injury: is it ready for primetime? J Trauma 60:925–929PubMedGoogle Scholar
  16. 16.
    Edwards NM, Fabian TC, Claridge JA, Timmons SD, Fischer PE, Croce MA (2007) Antithrombotic therapy and endovascular stents are effective treatment for blunt carotid injuries: results from long-term follow-up. J Am Coll Surg 204:1007–1013PubMedCrossRefGoogle Scholar
  17. 17.
    Mayberry JC, Brown CV, Mullins RJ, Velmahos GC (2004) Blunt carotid artery injury: the futility of aggressive screening and diagnosis. Arch Surg 139:609–612PubMedCrossRefGoogle Scholar
  18. 18.
    Eachempati SR, Vaslef SN, Sebastian MW, Reed RL (1998) Blunt vascular injuries of the head and neck: is heparinization necessary? J Trauma 45:997–1004PubMedGoogle Scholar
  19. 19.
    Berne JD, Norwood SH, McAuley CE, Villareal DH (2004) Helical computed tomographic angiography: an excellent screening test for blunt cerebrovascular injury. J Trauma 57:11–17PubMedCrossRefGoogle Scholar
  20. 20.
    Cothren CC, Moore EE, Ray CE, Ciesla DJ, Johnson JL, Moore JB, Burch JM (2005) Carotid artery stents for blunt cerebrovascular injury: risks exceed benefits. Arch Surg 140:480–485PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Konstantinos Spaniolas
    • 1
  • George C. Velmahos
    • 1
  • Hasan B. Alam
    • 1
  • Marc de Moya
    • 1
  • Malek Tabbara
    • 1
  • Elizabeth Sailhamer
    • 1
  1. 1.Division of Trauma, Emergency Surgery and Surgical Critical CareMassachusetts General Hospital and Harvard Medical SchoolBostonUSA

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