Blunt cerebrovascular injury screening guidelines

Abstract

Diagnostic study, level III.

Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

“…Specifically, the cost of stroke was calculated by dividing the lifetime stroke cost obtained by the difference between the average age at occurrence of BCVI (40 years of age) and the average life span of people in the United States (78.9 years of age). 6,7,[19][20][21] We acknowledge that our methodology for calculating the cost might be inaccurate, but the value is close to that reported in recent literature. 22 A list of all parameters and their values is presented on the On-line Table. There are several assumptions made in this model:…”

“…Four studies reported the number of BCVIs with high-risk factors, and the weighted average was obtained to extrapolate the incidence of BCVI in high-risk patients. 1,[6][7][8]18 The proportion of high-risk populations in all blunt trauma admissions was derived from the weighted average of 2 studies totaling nearly 30,000 patients. 6,7…”

“…[3][4][5] Multiple strategies have been suggested, generating debates between aggressive imaging for all blunt trauma admissions and selective screening of patients. [6][7][8] In a recent study, 30% of patients had no radiographic or clinical risk factors, and the authors proposed more liberalized screening for BCVI. 7 Digital subtraction angiography has been considered the reference standard for BCVI detection.…”

“…[6][7][8] In a recent study, 30% of patients had no radiographic or clinical risk factors, and the authors proposed more liberalized screening for BCVI. 7 Digital subtraction angiography has been considered the reference standard for BCVI detection. 9,10 Increasingly, CT angiography is used in emergency departments to assess patients.…”

Blunt Cerebrovascular Injuries: Advances in Screening, Imaging, and Management Trends

“…9,10 Initially, digital subtraction angiography was used for diagnosis, but with advances in technology, CTA is considered the imaging technique of choice, with a sensitivity and specificity of nearly 98% and 100%, respectively. 11,12 Various screening criteria have been proposed for patients with blunt trauma, with the Modified Denver Criteria being the most accepted [13][14][15] ; however, other criteria (such as the Memphis Criteria 16 and Boston Criteria 17 ) may make implementation of protocol confusing and challenging for practitioners. Also, there are no specific guidelines for screening these injuries in the pediatric population.…”