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

Malhotra, Ajay; Wu, Xiao; Kalra, Vivek B.; Schindler, Joseph; Matouk, Charles; Forman, Howard P.

doi:10.3174/ajnr.a4515

Cited by 43 publications

(20 citation statements)

References 33 publications

(55 reference statements)

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“…There seem to be a clear correlation between improved CT technology and diagnostic accuracy: Modern CT scanners with 16-, 32- and 64 -channel technology demonstrate higher sensitivity and specificity with increasing number of slices per rotation [ 58 , 59 , 61 – 63 ]. In a cost-effectiveness study by Malhotra et al CTA was found to be superior to DSA in patients selected for imaging based on the Denver screening criteria [ 42 ]. Eastman and co-workers significantly reduced time from injury to diagnosis of BCVI from 31.2 h to 2.65 h when converting from DSA to CTA.…”

Section: Resultsmentioning

confidence: 99%

Best practice guidelines for blunt cerebrovascular injury (BCVI)

Brommeland

Helseth

Aarhus

et al. 2018

Scand J Trauma Resusc Emerg Med

106

126

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Blunt cerebrovascular injury (BCVI) is a non-penetrating injury to the carotid and/or vertebral artery that may cause stroke in trauma patients. Historically BCVI has been considered rare but more recent publications indicate an overall incidence of 1–2% in the in-hospital trauma population and as high as 9% in patients with severe head injury. The indications for screening, treatment and follow-up of these patients have been controversial for years with few clear recommendations. In an attempt to provide a clinically oriented guideline for the handling of BCVI patients a working committee was created. The current guideline is the end result of this committees work. It is based on a systematic literature search and critical review of all available publications in addition to a standardized consensus process. We recommend using the expanded Denver screening criteria and CT angiography (CTA) for the detection of BCVI. Early antithrombotic treatment should be commenced as soon as considered safe and continued for at least 3 months. A CTA at 7 days to confirm or discard the diagnosis as well as a final imaging control at 3 months should be performed.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0559-1) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Best practice guidelines for blunt cerebrovascular injury (BCVI)

Brommeland

Helseth

Aarhus

et al. 2018

Scand J Trauma Resusc Emerg Med

106

126

View full text Add to dashboard Cite

show abstract

“…The estimated incidence of BCVI among all blunt trauma patients, presenting in high-volume, well equipped trauma centers is around 1-2% [12,13]. Although aggressive screening has led to the identification of more BCVI cases, debates remain due to costs and potential complications caused by (invasive) screening methods such as angiography [14][15][16]. Therefore, a standard screening method with high accuracy and low complication rate is needed for an adequate evaluation of the true incidence of BCVI.…”

Section: Introductionmentioning

confidence: 99%

Blunt cerebrovascular injury: incidence and long-term follow-up

Hundersmarck

Slooff

Homans

et al. 2019

Eur J Trauma Emerg Surg

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Purpose Blunt cerebrovascular injuries (BCVI), which can result in ischemic stroke, are identified in 1-2% of all blunt trauma patients. Computed tomography angiography (CTA) scanning has improved and is the diagnostic modality of choice in BCVI suspected patients. Data about long-term functional outcomes and the incidence of ischemic stroke after BCVI are limited. The aim of this study was to determine BCVI incidence in relation to imaging modality improvements and to determine long-term functional outcomes. Methods All consecutive trauma patients from 2007 to 2016 with BCVI were identified from the level 1 trauma center prospective trauma database. Three periods were identified where CTA diagnostic modalities for trauma patients were improved. Long-term functional outcomes using the EuroQol six-dimensional (EQ-6D™) were determined. Results Seventy-one BCVI patients were identified among the 12.122 (0.59%) blunt trauma patients. In the first period BCVI incidence among the overall study cohort, polytrauma, basilar skull fracture and cervical trauma subgroups was found to be 0.3%, 0.9%, 1.2%, 4.6%, respectively, which more than doubled towards the third period (0.8, 2.4, 1.9 and 8.5% respectively). Ischemic stroke as a result of BCVI was found in 20 patients (28%). In-hospital stroke rate was lower in patients receiving antiplatelet therapy (p < 0.01). Six in-hospital deaths were BCVI related. Long-term follow-up (follow-up rate of 83%) demonstrated lower functional outcomes compared to Dutch reference populations (p < 0.01). Ischemic stroke was identified as a major cause of functional impairment at long-term follow-up. Conclusions Improved CTA diagnostic modalities have increased BCVI incidence. Furthermore, BCVI patients reported significant functional impairment at long-term follow-up. Antiplatelet therapy showed a significant effect on in-hospital stroke rate reduction.

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“…For instance, firstly, DSA is an invasive method of examination with excellent sensitivity, but its risk implies it should not be used as a preferred item for patients [73]. Secondly, the cost of DSA inspections is still a factor that cannot be ignored [74]. Thirdly, the difficulty of DSA operation, including requirements for contrast dose and pressure for injection, is also a major challenge for clinicians [75].…”

Section: Multiple Imaging Technologies For Tiamentioning

confidence: 99%

Imaging Diagnosis of Transient Ischemic Attack in Clinic and Traditional Chinese Medicine

Yao

Zhang

Zhou

et al. 2019

BioMed Research International

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Neuroimaging plays a pivotal role in Transient Ischemic Attack (TIA). Generally, clinicians focus on the specific changes in morphology and function, but the diagnosis of TIA often depends on imaging evidence. Whereas Traditional Chinese Medicine (TCM) is concerned with the performance of clinical symptoms, they began to use imaging methods to diagnose TIA. CT and MRI are the recommended modality to diagnose TIA and image ischemic lesions. In addition, Transcranial Doppler sonography (TCD) and Digital Subtraction Angiography (DSA) are two acceptable alternatives for diagnosing TIA patients. This article elaborates the update of imaging modalities in clinic and the development of imaging modalities in TCM. Besides, multiple joint imaging technologies also will be evaluated whether enhanced diagnostic yields availably.

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

Cited by 43 publications

References 33 publications

Best practice guidelines for blunt cerebrovascular injury (BCVI)

Best practice guidelines for blunt cerebrovascular injury (BCVI)

Blunt cerebrovascular injury: incidence and long-term follow-up

Imaging Diagnosis of Transient Ischemic Attack in Clinic and Traditional Chinese Medicine

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