Universal screening for blunt cerebrovascular injury

Black, Jonathan; Abraham, Peter; Abraham, Mackenzie N.; Cox, Daniel; Griffin, Russell; Holcomb, John B.; Hu, Parker; Kerby, Jeffrey D.; Liptrap, Elizabeth; Thaçi, Bart; Harrigan, Mark R.; Jansen, Jan O.

doi:10.1097/ta.0000000000003010

Cited by 14 publications

(15 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In their study, 6287 of 6800 (92.5%) blunt trauma patients underwent CTA of the neck, identifying 480 BCVIs (7.6%). 14 They similarly demonstrated that 25.3% of patients with BCVI identified with universal screening had none of the clinical risk factors included in the expanded Denver criteria.…”

Section: Discussionmentioning

confidence: 94%

“…Since publication of these initial recommendations, screening has commonly been based on the Denver criteria and its subsequent revision, the New Denver Health BCVI Screening Guidelines or expanded Denver criteria (figure 1). 6 10–12 Despite advances in imaging technology and expansion of screening criteria, a number of studies have suggested that the current recommendations for screening for BCVIs, such as the expanded Denver criteria, fail to identify as many as 37% of injuries 7 13–16…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Routine CTA screening identifies blunt cerebrovascular injuries missed by clinical risk factors

Harper

Jacobson

Sheff

et al. 2022

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

ObjectivesCurrent guidelines for screening for blunt cerebrovascular injury (BCVI) are commonly based on the expanded Denver criteria, a set of risk factors that identifies patients who require CT-angiographic (CTA) screening for these injuries. Based on previously published data from our center, we have adopted a more liberal screening guideline than those outlined in the expanded Denver criteria. This entails routine CTA of the neck for all blunt trauma patients already undergoing CT of the cervical spine and/or CTA of the chest. The aim of this study was to analyze the incidence of patients with BCVI who did not meet any of the risk factors included in the expanded Denver criteria.MethodsA retrospective review of all patients diagnosed with BCVI between June 2014 and December 2019 at a Level I Trauma Center were identified from the trauma registry. Medical records were reviewed for the presence or absence of risk factors as outlined in the expanded Denver criteria. Demographic data, time to CTA and treatment, BCVI grade, Glasgow Coma Scale and Injury Severity Score were collected.ResultsDuring the study period, 17 054 blunt trauma patients were evaluated, and 29% (4923) underwent CTA of the neck to screen for BCVI. 191 BCVIs were identified in 160 patients (0.94% of all blunt trauma patients, 3.25% of patients screened with CTA). 16% (25 of 160) of patients with BCVI had none of the risk factors outlined in the Denver criteria.ConclusionOur findings indicate that reliance on the expanded Denver criteria alone for BCVI screening will result in missed injuries. We recommend CTA screening in all patients with blunt trauma undergoing CT of the cervical spine and/or CTA of the chest to minimize this risk.Level of evidenceLevel III, therapeutic/care management.

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Routine CTA screening identifies blunt cerebrovascular injuries missed by clinical risk factors

Harper

Jacobson

Sheff

et al. 2022

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

show abstract

“…In 2016, our institution adopted a protocol that includes universal screening for BCVI in blunt trauma patients using a 256-slice neck computed tomographic angiography (CTA). 5 All patients who are suspected of having clinical evidence of a stroke undergo a magnetic resonance imaging (MRI) scan of the brain as part of a standard evaluation for ischemic stroke. Brain MRI permits high-resolution imaging of ischemic brain lesions; allows the differentiation of acute ischemic lesions from remote strokes and other lesions that are common in trauma patients, such as contusions; and enables association with BCVI lesions by identifying the brain territory affected by the ischemic lesions.…”

mentioning

confidence: 99%

Imaging analysis of ischemic strokes due to blunt cerebrovascular injury

Abraham

Black

Griffin

et al. 2022

J Trauma Acute Care Surg

Self Cite

View full text Add to dashboard Cite

BACKGROUNDThe timing of stroke onset among patients with blunt cerebrovascular injury (BCVI) is not well understood. All blunt trauma patients at our institution undergo a screening computed tomographic angiography (CTA) of the neck. Most patients with CTA evidence of BCVI are treated with aspirin, and all patients with clinical evidence of stroke are treated with aspirin and undergo magnetic resonance imaging (MRI) of the brain. We conducted a retrospective review to determine the incidence of stroke upon admission and following admission.METHODSAll neck CTAs and head MRIs obtained in blunt trauma patients were reviewed from August 2017 to August 2019. All CTAs that were interpreted as showing BCVI were individually reviewed to confirm the diagnosis of BCVI. Stroke was defined as brain MRI evidence of new ischemic lesions, and each MRI was reviewed to identify the brain territory affected. We extracted the time to aspirin administration and the timing of stroke onset from patients' electronic health records.RESULTSOf the 6,849 blunt trauma patients, 479 (7.0%) had BCVIs. Twenty-four patients (5.0%) with BCVI had a stroke on admission. Twelve (2.6%) of the remaining 455 patients subsequently had a stroke during their hospitalization. The incidence of stroke among patients with BCVI was 7.5%; 2.6% were potentially preventable. Only 5 of the 12 patients received aspirin before the onset of stroke symptoms. All 36 patients with BCVI and stroke had thromboembolic lesions in the territory supplied by an injured vessel.CONCLUSIONWith universal screening, CTA evidence of BCVI is common among blunt trauma patients. Although acute stroke is also relatively common in this population, two thirds of strokes are already evident on admission. One third of BCVI-related strokes occur after admission and often relatively early, necessitating rapid commencement of preventative treatment. Further studies are required to demonstrate the value of antithrombotic administration in preventing stroke in BCVI patients.LEVEL OF EVIDENCEPrognostic and Epidemiologic; Level IV.

show abstract

“…Since this time, with the advent of improved multi-slice computer tomography angiography (CTA), there has been an increasing number of publications regarding expanded BCVI criteria, including universal screening for BCVI. 3,4 Although this was an interesting read, several critical data points were missing from the analysis. One such data point is a follow-up CTA.…”

mentioning

confidence: 99%

mentioning

confidence: 99%