Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
BCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke.
Denver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT angiography (CTA) over a period of 38 months were reviewed retrospectively by two Fellowship-trained radiologists, as well as any cerebral imaging after the initial trauma.
1544 WBCT studies included 374 CTA (m/f = 271/103; mean age 41.5 years). Most common mechanisms of injury were MVA (51.5%) and fall from a height (22.3%). We found 72 BCVI in 56 patients (15.0%), with 13 (23.2%) multiple lesions. The ICA was affected in 49 (68.1%) and the vertebral artery in 23 (31.9%) of cases. The most common injury level was C2, with Biffl grades I and II most common in ICA, and II and IV in VA. Interobserver agreement was substantial (Kappa = 0.674). Of 215 patients imaged, 16.1% with BCVI and 1.9% of the remaining cases had cerebral ischemic stroke (p < .0001; OR = 9.77; 95% CI 3.3–28.7). Eleven percent of patients with BCVI would not have met standard screening criteria.
The increase in detection rate for BCVI justifies more liberal screening protocols.
Cothren CC, Moore JE, Biffl WL et al (2004) Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg 139(5):540–545 CrossRef
Bromberg WJ, Collier BC, Diebel LN et al (2010) Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma 68(2):471–477 PubMed
George E, Khandelwal A, Potter C et al (2018, 2018) Blunt traumatic vascular injuries of the head and neck in the ED. Emerg Radiol. https://doi.org/10.1007/s10140-018-1630-y
Jaevons C, Hacking C, Beenen LF, Gunn ML (2017) A review of split-bolus single pass CT in the assessment of trauma patients. Emerg Radiol 25:367–374 CrossRef
Liang T, Tso DK, Chiu RYW, Nicolaou S (2013) Imaging of blunt vascular neck injuries: a review of screening and imaging modalities. Am J Roentgenol 201(4):884–892 CrossRef
Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, Burch JM (1999) Optimizing screening for blunt cerebrovascular injuries. Am J Surg 178:517–522 CrossRef
Donker DK, Hasman A, Van Geijn HP (1993) Interpretation of low kappa values. Comput Int J Biomed 33:55–64 CrossRef
Jacobson LE, Ziemba-davis M, Herrera AJ (2015) The limitations of using risk factors to screen for blunt cerebrovascular injuries: the harder you look, the more you find. World J Emerg Surg 26(10):46 CrossRef
Grabkowski G, Robertson RN, Barton BM et al (2016) Blunt cerebrovascular injury in cervical spine fractures: are more liberal screening criteria warranted? Global Spine J 6:679–685 CrossRef
Deutsche Gesellschaft für Unfallchirurgie (DGU) (2015) Trauma register DGU ® TR-DGU. Available from: http://www.traumaregister-dgu.de/fileadmin/user_upload/traumaregister-dgu.de/docs/Downloads/TR-DGU-Jahresbericht_2015.pdf
Malhotra AK, Camacho M, Ivatury RR, Davis IC, Komorowski DJ, Leung DA, Grizzard JD, Aboutanos MB, Duane TM, Cockrell C, Wolfe LG, Borchers CT, Martin NR (2007) Computed tomographic angiography for the diagnosis of blunt carotid / vertebral artery injury: a note of caution. Ann Surg 246(4):632–643 CrossRefPubMed
- Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke
Frank V. Bensch
Elina A. Varjonen
Tuomo T. Pyhältö
Seppo K. Koskinen
- Springer International Publishing
Neu im Fachgebiet Radiologie
Meistgelesene Bücher aus der Radiologie
Mail Icon II