Elderly Patients With Cervical Spine Fractures After Ground Level Falls Are at Risk for Blunt Cerebrovascular Injury Elizabeth Gorman, MD,* Charles DiMaggio, PhD, Spiros Frangos, MD, MPH, Michael Klein, MD, Cherisse Berry, MD, and Marko Bukur, MD Department of Surgery, NYU Langone Health, Bellevue Hospital Center, New York, New York article info Article history: Received 12 July 2019 Received in revised form 14 March 2020 Accepted 24 March 2020 Available online xxx Keywords: Cervical spine injuries Elderly Trauma CTA abstract Background: Osteopenia is common in the elderly, increasing their risk of sustaining cer- vical fractures after ground level falls (GLFs). We sought to examine the incidence of blunt cerebrovascular injury (BCVI) and subsequent stroke in elderly GLF patients as compared with other higher injury mechanisms. Materials and methods: The Trauma Quality Improvement Program database (2011-2016) was used to identify blunt trauma patients with isolated (other body region abbreviated injury scale <3) cervical spine (C1-C7) fractures. Patients were stratified into three groups: non- elderly patients (<65) with all mechanisms of injury, elderly patients (65) with GLF, and elderly patients with all other mechanism of injury. Multivariable logistic regression was used to determine predictors for BCVI, stroke, spinal cord injury, and acute kidney injury. Results: Seventeen thousand six hundred twenty-eight patients with cervical spine injuries were identified. BCVI was highest in the <65 group (0.8%) and lowest in elderly patients with GLF (0.3%, P ¼ 0.001). When controlling for other factors, elderly patients with GLF were less likely to sustain BCVI (adjusted odds ratio: 0.46, P ¼ 0.03) but had comparable rates of stroke attributable to BCVI (18.2% versus 6.5%, P ¼ 0.184) and comparable rate of acute kidney injury compared with elderly patients with other mechanism of injury. Conclusions: In elderly patients with isolated cervical spine fracture after GLF, BCVI occurs less frequently but is associated with a comparable rate of stroke as compared with other mechanisms. Low injury mechanism should not preclude BCVI screening in the presence of cervical spine fractures. ª 2020 Elsevier Inc. All rights reserved. Introduction The elderly population in the United States is rapidly growing. It is projected that more than 20% of the population will be older than 65 y by the year 2040. 1,2 After traumatic injury, elderly patients experience higher mortality rates than younger patients, even after presenting with similar injury severity. This is multifactorial; poor cardiopulmonary reserve, polypharmacy, and increased medical comorbidities can contribute to poor outcomes. 1 Falls are common in the elderly This article was selected for oral presentation at Academic Surgical Congress in Houston, TX, February 7, 2019. * Corresponding author. Department of Surgery, NYU Langone Health, Bellevue Hospital Center, 462 First Avenue, New York, NY 10016. Tel.: 212 263 2225; fax: 212- 263-8216. E-mail address: Elizabeth.warnack@nyumc.org (E. Gorman). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  september 2020 (253) 100 e104 0022-4804/$ e see front matter ª 2020 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jss.2020.03.036