Screening Multidetector Computed Tomography Angiography in the Evaluation on Blunt Neck Injuries: An Evidence-Based Approach

Anaya, Carlos; Múnera, Felipe; Bloomer, Courtnay W.; Danton, Gary H.; Caban, Kim

doi:10.1053/j.sult.2009.02.003

Cited by 29 publications

(20 citation statements)

References 48 publications

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“…At our institution, the selection of trauma patients for BCVI screening is based on the injury mechanism, physical signs, and associated injuries according to the Denver Criteria 22,23 . The risk-based screening mechanism has shown a high yield, with BCVI found in 27% to 44% of patients with risk factors 2,6,7,14,15 . The high incidence of BCVI in our study population shows that a risk-based selection mechanism is an effective practice to screen for BCVI in blunt trauma patients.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that with the application of non-selective screening protocols, BCVI can be found in 1 to 3% of all blunt trauma patients 14,18 . Although screening all trauma patients for BCVI maximizes the detection rate, the implementation of such a screening protocol may be unrealistic in most centres due to the burden on the health system given its resource intensive nature.…”

Section: Discussionmentioning

confidence: 99%

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Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

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574In recent years, blunt cerebrovascular injury (BCVI) is gaining attention as an important sequela of nonpenetrating trauma to the neck and skull base. Blunt cerebrovascular injury affects approximately 1% of all blunt trauma admissions, and the reported incidence is as high as 2.7% in centres with aggressive screening protocols [1][2][3][4][5][6][7][8] . The pattern of BCVI consists of vascular transection, dissection, thrombosis, and formation of pseudoaneurysm or arteriovenous fistula (AVF) 9,10 . The majority of these injuries occur during motor vehicle accidents, with variable rates of carotid and vertebral artery involvement reported in the literature [11][12][13] . If untreated, BCVI can be fatal and result in devastating neurological sequelae, with mortality and morbidity rates reported up to 38% and 67% respectively 14 .One of the difficulties in initiating treatment for BCVI is related to the variable symptomatology. While approximately ABSTRACT: Background: Blunt cerebrovascular injury (BCVI) to the carotid and vertebral arteries is a potentially devastating injury in trauma patients. The optimal management for BCVI has not been standardized. At our institution, 64-slice multi-detector computed tomographic angiography (CTA) has been used as the initial screening exam for BCVI in patients who met predefined screening criteria. The purpose of this study is to review the incidence of CTA-diagnosed BCVI in at-risk patients and to evaluate the treatment and clinical outcome of patients with BCVI. Methods: This study included trauma patients with a positive diagnosis of BCVI on CTA during a 41-month study period. The medical records and relevant radiographic findings were retrospectively reviewed. Results: Twenty seven of 222 blunt trauma patients evaluated with CTA had a positive diagnosis of BCVI, with an occurrence rate of 12.2%. Traumatic brain injury (72.2%) and basal skull fractures (55.6%) were the most frequent associated injuries with carotid trauma while 100% of blunt vertebral injuries occurred in the setting of cervical fractures. Fourteen (51.8%) patients received medical therapy; Eleven (40.7%) patients received conservative treatment. Endovascular treatment was attempted in a single case of vertebral arteriovenous fistula. BCVI-related stroke was found in four patients (14.8%), one of whom developed an infarct while on medical treatment. Conclusions: BCVI is found in a significant portion of blunt trauma patients with identifiable risk factors, and screening CTA has high diagnostic yield in detecting these lesions. Medical therapy is the mainstay of treatment at our institution; however, BCVI-related stroke may occur despite treatment. RÉSUMÉ: Diagnostic et résultats du traitement des traumatismes cérébrovasclaires contondants. Contexte :Le traumatisme cérébrovasculaire contondant (TCVC) à la carotide et aux artères vertébrales est une lésion qui peut être dévastatrice chez les patients qui ont subi un traumatisme. Le traitement optimal du TCVC n'a pas été standardisé. Dans notre institutio...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

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“…2,18 Concerns regarding CTA as the sole screening modality for BCVI are highlighted in literature reviews. Anaya et al 19 reported an overall sensitivity of only 76.8% for detecting BCVI. Those reports are difficult to interpret because not all patients underwent both CTA and DSA, and they include many generations of CT scanner technology.…”

mentioning

confidence: 97%

Blunt Cerebrovascular Injury Screening With 32-Channel Multidetector Computed Tomography

DiCocco¹,

Emmett²,

Fabian³

et al. 2011

Annals of Surgery

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“…[56][57][58][59] While digital subtraction angiography is considered the gold standard modality for diagnosing BCVI, it is not without risk, and availability depends on local expertise. 60 Suggested expanded screening criteria include both signs and symptoms of BCVI (i.e., arterial bleeding, cervical bruit, expanding hematoma, focal neurologic deficit, neurologic examination incongruous with head CT findings, stroke on secondary CT or magnetic resonance imaging [MRI]), as well as high-risk injury mechanisms and fracture patterns in asymptomatic patients (i.e., cervical spine fractures, traumatic brain injury [TBI] with thoracic injury, and Le Fort II or III facial fractures, among others). 57 Fracture patterns with the greatest risk of carotid and vertebral artery injury in traumatic SCI patients include cervical spine fractures involving C1 to C3, cervical fracture subluxations, and cervical fractures extending to the foramen transversarium.…”

Section: Hematologicalmentioning

confidence: 99%

Critical Care Management of Acute Spinal Cord Injury—Part II: Intensive Care to Rehabilitation

Sacino

Rosenblatt

2019

Journal of Neuroanaesthesiology and Critical Care

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Spinal cord injury is devastating to those affected due to the loss of motor and sensory function, and, in some cases, cardiovascular collapse, ventilatory failure, and bowel and bladder dysfunction. Primary trauma to the spinal cord is exacerbated by secondary insult from the inflammatory response to injury. Specialized intensive care of patients with acute spinal cord injury involves the management of multiple systems and incorporates evidence-based practices to reduce secondary injury to the spinal cord. Patients greatly benefit from early multidisciplinary rehabilitation for neurologic and functional recovery. Treatment of acute spinal cord injury may soon incorporate novel molecular agents currently undergoing clinical investigation to assist in neuroprotection and neuroregeneration.

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Screening Multidetector Computed Tomography Angiography in the Evaluation on Blunt Neck Injuries: An Evidence-Based Approach

Cited by 29 publications

References 48 publications

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Blunt Cerebrovascular Injury Screening With 32-Channel Multidetector Computed Tomography

Critical Care Management of Acute Spinal Cord Injury—Part II: Intensive Care to Rehabilitation

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