Blunt Carotid Arterial Injuries: Implications of a New Grading Scale

Biffl, Walter L.; Moore, Ernest E.; Offner, Patrick J.; Brega, Kerry E.; Franciose, Reginald J.; Burch, Jon M.

doi:10.1097/00005373-199911000-00004

Cited by 519 publications

(408 citation statements)

References 18 publications

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“…2 Types of accidents that caused blunt cerebrovascular injuries Fig. 3 Types of lesions based on classification by Biffl et al [6] which did not integrate the CTA into their primary diagnostics. In those cases, the CTA was performed when the patient admitted to our hospital.…”

Section: Resultsmentioning

confidence: 99%

“…These factors and tracer diagnoses have been introduced by the Denver [6] and Memphis trauma groups [16] and have been used in many studies [8,13,14].…”

Section: Discussionmentioning

confidence: 99%

“…Inclusion criteria were cervical spine fractures, fractures of the transverse foramen, odontoid fractures, C1 fractures, incomplete or complete atlantooccipital dislocations, skull base fractures, midface fractures (LeFort type III), seat belt injuries with cervical soft tissue marks, expanding cervical haematoma, cervical bleeding, diffuse axonal injuries with initial Glasgow coma scale \6, neurological deficit without radiological signs and trauma combined with a stroke (Table 1). These tracer injuries for BCVIs are geared to the criteria which were introduced by Biffl and colleagues of Denver [6] and Fabian and colleagues of Memphis [16].…”

Section: Inclusion Criteriamentioning

confidence: 99%

“…Aside from the height of the BCVI, every lesion was classified according to the Biffl grading scale [6] ( Table 2). Although this scale was originally developed for the classification of blunt injuries of the carotid arteries, we …”

Section: Screening Protocol and Diagnostic Cascadementioning

confidence: 99%

“…For a feasible and timely implementation of the diagnostic and therapeutic routine into a trauma centre level 1, a sensitive preselection of patients by means of clearly defined inclusion criteria is indispensable. Guidance is given by the factors which were recommended by the Denver [6] and Memphis [16] trauma groups. By using the current screening protocol, our detection rate improved from 0.07 and 2.75-36.3%.…”

Section: C1 Fracturementioning

confidence: 99%

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Blunt cerebrovascular injuries in acute trauma care: a screening protocol

et al. 2011

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Introduction Blunt cerebrovascular injuries (BCVI) of the extra-or intracerebral vessels are frequently observed lesions which may lead to thrombembolic events with focal neurological deficits, stroke or death particularly in patients \60 years. However, a comprehensive standardised clinical algorithm for screening and management of these secondary injuries is still lacking. Materials and methods We developed a standardised screening protocol applicable for mild as well as severely injured patients. In this prospective cohort study, we evaluated the feasibility of this diagnostic algorithm in a level 1 trauma centre setting. Trauma patients who met the inclusion criteria underwent a computed tomographic angiography (CTA) as part of standard diagnostic procedure at admission. All suspicions or positive findings were reevaluated by a conventional four-vessel catheter angiography within the first 72 h after trauma. Within this period, anticoagulation with low-dose heparin was started. BCVI confirmation indicated a shift to systemic heparinisation with overlapping phenprocoumon therapy for at least 6 months. All patients were reevaluated after 6 months by another four-vessel angiography. Depending on the diagnostic findings, oral anticoagulation may be discontinued or continued for another 6 months.Results A total of 44 patients (8 male, 6 female, age range 19-95 years) were included in the study. 20 BCVIs were detected in 16 patients (36.3%). The most common injuries identified were Biffl Type II (40%) and Type IV lesions (30%). 86.4% of the patients received a CTA upon admission, 93.2% of which were conducted within 12 h posttrauma. None of the patients had a secondary thrombembolic neurological event during the hospital stay or within 3 months postdischarge. Conclusion Our results indicate that implementation of the screening protocol can prevent strokes in patients without primary thrombembolic neurological deficits.

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Section: Resultsmentioning

confidence: 99%

“…These factors and tracer diagnoses have been introduced by the Denver [6] and Memphis trauma groups [16] and have been used in many studies [8,13,14].…”

Section: Discussionmentioning

confidence: 99%

Section: Inclusion Criteriamentioning

confidence: 99%

Section: Screening Protocol and Diagnostic Cascadementioning

confidence: 99%

Section: C1 Fracturementioning

confidence: 99%

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Blunt cerebrovascular injuries in acute trauma care: a screening protocol

et al. 2011

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Anticoagulation Is the Gold Standard Therapy for Blunt Carotid Injuries to Reduce Stroke Rate

Cothren¹

2004

Arch Surg

265

186

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blunt trauma admissions to our level I center, of which 643 underwent screening angiography for blunt CAI on the basis of a protocol including injury patterns and symptoms. Patients without contraindications underwent anticoagulation immediately for documented lesions.Setting: A state-designated, level I urban trauma center.Patients: Of the 643 patients undergoing screening angiography, 114 (18%) had confirmed CAI.Intervention: Early angiographic diagnosis and prompt anticoagulation.Main Outcome Measures: Diagnosis, stroke rate, and complications stratified by method of intervention.Results: A CAI was identified in 114 patients during the 7-year study period; the majority were men (71%), with a mean±SD age of 34±1.3 years and a mean±SD Injury Severity Score of 29±1.5. Seventy-three patients underwent anticoagulation after diagnosis (heparin in 54, lowmolecular-weight heparin in 2, antiplatelet agents in 17); none had a stroke. Of the 41 patients who did not receive anticoagulation (because of a contraindication in 27, symptoms before diagnosis in 9, and carotid coil or stent in 5), 19 patients (46%) developed neurologic ischemia. Ischemic neurologic events occurred in 100% of patients who presented with symptoms before angiographic diagnosis and those receiving a carotid coil or stent without anticoagulation.Conclusions: Our prospective evaluation of blunt CAIs suggests that early diagnosis and prompt anticoagulation reduce ischemic neurologic events and their disability. The optimal anticoagulation regimen, however, remains to be established.

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Blunt Carotid Artery Injury

et al. 2004

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Background: Blunt carotid artery injury (BCI) remains a rare but potentially lethal condition. Recent studies recommend that aggressive screening based on broad criteria (hyperextension-hyperflexion mechanism of injury, basilar skull fracture, cervical spine injury, midface fracture, mandibular fracture, diffuse axonal brain injury, and neck seat-belt sign) increases the rate of diagnosis of BCI by 9-fold. If this recommendation becomes a standard of care, it will require a major consumption of resources and may give rise to liability claims. The benefits of aggressive screening are unclear because the natural history of asymptomatic BCI is unknown and the existing treatments are controversial. Hypothesis:The lack of an aggressive angiographic screening protocol does not result in delayed BCI diagnosis or BCI-related neurologic deficits.Methods: A 10-year medical record review of patients with BCI was undertaken in 2 level I academic trauma centers. In both centers, urgent screening for BCI was performed in patients with focal neurologic signs or neurologic symptoms unexplainable by results of computed tomography of the brain as well as in selected patients undergoing angiography for another reason.(REPRINTED) ARCH SURG/ VOL 139, JUNE 2004 WWW.ARCHSURG.COM 609

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Blunt Carotid Arterial Injuries: Implications of a New Grading Scale

Cited by 519 publications

References 18 publications

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

Anticoagulation Is the Gold Standard Therapy for Blunt Carotid Injuries to Reduce Stroke Rate

Blunt Carotid Artery Injury

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