Prospective Screening for Blunt Cerebrovascular Injuries

Miller, Preston R.; Fabian, Timothy C.; Croce, Martin A.; Cagiannos, Catherine; Williams, James S.; Vang, Meng C.; Qaisi, Waleed G.; Felker, Richard E.; Timmons, Shelly D.

doi:10.1097/00000658-200209000-00015

Cited by 472 publications

(502 citation statements)

References 15 publications

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“…Traumatic cerebrovascular injuries of the extra-or intracerebral vessels (BCVI) are often missed in primary diagnostics and leads to neurological deficits in 23-58% of cases [7,8,21]. In more than 30% of cases, the diagnostics for BCVI are not started until a symptom caused by the vessel injury appears [20].…”

Section: Discussionmentioning

confidence: 99%

“…Because of an incidence of 0.24-1.03% in all casualties of blunt cerebrovascular injuries [5,7,12,20,21], a feasible screening algorithm which considers on factors and tracer diagnoses that determines a BCVI is strongly required. 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%

“…In acute trauma care, cerebrovascular injuries of the extraor intracerebral vessels (also called blunt cerebrovascular injuries or BCVI) occur in 13-39% of cases following blunt trauma of the neck and the head [5,21,29]. If left untreated, these lesions often lead to thrombembolic events with focal neurologic deficits, stroke or death particularly in young patients below 60 years [24].…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Blunt cerebrovascular injuries in acute trauma care: a screening protocol

et al. 2011

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“…In total, 605 (4.8%) and 216 (3.5%) patients admitted to their respective centres underwent DSA, detecting VAI in 15 and 20% of cases. 4,5 Cervical spine fractures were present in more than 70% of patients. Screening protocols used in both centres advised angiography in all cervical spine fractures.…”

Section: Discussionmentioning

confidence: 99%

“…In an analysis of the three methods, CTA and MRA demonstrated sensitivities of 53 and 47% for blunt VAI compared to the accepted gold standard of DSA. 5 Further advances in noninva- sive radiological imaging, specifically CTA, now pose exciting alternatives for screening. Multisection CTA provides high-resolution and high-contrast images of the arterial lumen and wall.…”

Section: Discussionmentioning

confidence: 99%

Blunt cervical spine trauma as a cause of spinal cord injury and delayed cortical blindness

et al. 2006

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

Cothren¹

2004

Arch Surg

270

188

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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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Prospective Screening for Blunt Cerebrovascular Injuries

Cited by 472 publications

References 15 publications

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

Blunt cervical spine trauma as a cause of spinal cord injury and delayed cortical blindness

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

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