Vertebral artery injury in patients presenting to the emergency department with cervical spine fractures: national trends, predictors, and cerebrovascular outcomes.
- 1Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520, United States.
- 2Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT 06510, United States.
Abstract
Background
Vertebral artery injury (VAI) is an uncommon but serious sequela of cervical spine trauma, with a varying reported incidence. Prior studies have been limited by small sample size and inconsistent follow-up. This study identified predictors of VAI in emergency department (ED) patients with cervical fractures and evaluated the association with ninety-day stroke.Methods
Adult patients presenting to the ED with acute cervical fractures were identified in the 2010-2022 PearlDiver Mariner M170 database, excluding those with less than ninety days of follow-up. Demographic, clinical and nonclinical characteristics were compared between patients with and without VAI diagnosed on the same day of presentation. Multivariable regression analysis identified independent predictors of VAI. Additionally, multivariate regression assessed VAI association with ninety-day stroke, adjusting for age, sex, and Elixhauser Comorbidity Index (ECI).Results
Among 153,948 patients with cervical fractures, VAI was noted in 777 (0.50%), increasing from 0.33% in 2010 to 0.76% in 2022 (p < .001). Independent predictors, in decreasing OR, included upper cervical fracture (OR 1.93), high-energy trauma (OR 1.88), ECI (relative to 0: 1-2, OR 1.77; 3-4, OR 1.38), insurance (relative to Medicare: commercial, OR 1.50; Medicaid, OR 1.51), male sex (OR 1.28), and younger age (per decade decrease, OR 1.01) (p < .05 each). VAI was independently associated with stroke (OR 3.62, p < .001).Conclusions
VAI detection increased over the study period, and several clinical and nonclinical factors independently predicted VAI. VAI conferred over 3-fold higher odds of ninety-day stroke. Early recognition of high-risk patients may guide strategies to reduce cerebrovascular complications.
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BibTeX
@article{jayaram2026vertebral,
title = {{Vertebral artery injury in patients presenting to the emergency department with cervical spine fractures: national trends, predictors, and cerebrovascular outcomes.}},
author = {Rahul H Jayaram and Arjun Aron and Kashif Qureshi and Anthony E Seddio and Fabrizio Darby and Amit Mahajan and Ajay Malhotra and Jonathan N Grauer},
journal = {North American Spine Society journal},
year = {2026},
month = sep,
doi = {10.1016/j.xnsj.2026.100950},
url = {https://europepmc.org/article/MED/42921393},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Vertebral artery injury in patients presenting to the emergency department with cervical spine fractures: national trends, predictors, and cerebrovascular outcomes.
AU - Rahul H Jayaram
AU - Arjun Aron
AU - Kashif Qureshi
AU - Anthony E Seddio
AU - Fabrizio Darby
AU - Amit Mahajan
AU - Ajay Malhotra
AU - Jonathan N Grauer
PY - 2026
DA - 2026/09/22
JO - North American Spine Society journal
DO - 10.1016/j.xnsj.2026.100950
UR - https://europepmc.org/article/MED/42921393
AB - Background Vertebral artery injury (VAI) is an uncommon but serious sequela of cervical spine trauma, with a varying reported incidence. Prior studies have been limited by small sample size and inconsistent follow-up. This study identified predictors of VAI in emergency department (ED) patients with cervical fractures and evaluated the association with ninety-day stroke.Methods Adult patients presenting to the ED with acute cervical fractures were identified in the 2010-2022 PearlDiver Mariner M170 database, excluding those with less than ninety days of follow-up. Demographic, clinical and nonclinical characteristics were compared between patients with and without VAI diagnosed on the same day of presentation. Multivariable regression analysis identified independent predictors of VAI. Additionally, multivariate regression assessed VAI association with ninety-day stroke, adjusting for age, sex, and Elixhauser Comorbidity Index (ECI).Results Among 153,948 patients with cervical fractures, VAI was noted in 777 (0.50%), increasing from 0.33% in 2010 to 0.76% in 2022 (p < .001). Independent predictors, in decreasing OR, included upper cervical fracture (OR 1.93), high-energy trauma (OR 1.88), ECI (relative to 0: 1-2, OR 1.77; 3-4, OR 1.38), insurance (relative to Medicare: commercial, OR 1.50; Medicaid, OR 1.51), male sex (OR 1.28), and younger age (per decade decrease, OR 1.01) (p < .05 each). VAI was independently associated with stroke (OR 3.62, p < .001).Conclusions VAI detection increased over the study period, and several clinical and nonclinical factors independently predicted VAI. VAI conferred over 3-fold higher odds of ninety-day stroke. Early recognition of high-risk patients may guide strategies to reduce cerebrovascular complications.
SN - 2666-5484
ER -