JOURNAL ARTICLE

Blunt cerebrovascular injury screening guidelines: what are we willing to miss?

Brandon Robert Bruns, Ronald Tesoriero, Joseph Kufera, Clint Sliker, Adriana Laser, Thomas M Scalea, Deborah M Stein
Journal of Trauma and Acute Care Surgery 2014, 76 (3): 691-5
24553535

BACKGROUND: Blunt cerebrovascular injury (BCVI) is reported to occur in approximately 2% of blunt trauma patients, with a stroke rate of up to 20%. Guidelines for BCVI screening are based on clinical and radiographic findings. We hypothesized that liberal screening of the neck vasculature, as part of initial computed tomographic (CT) imaging in blunt trauma patients with significant mechanisms of injury, identifies BCVI that may go undetected.

METHODS: As per protocol, patients at risk for significant injuries undergo a noncontrast head CT scan followed by a multislice CT scan (40-slice or 64-slice) incorporating an intravenous contrast-enhanced pass from the circle of Willis through the pelvis (whole-body CT [WBCT] scan). The trauma registry was retrospectively reviewed, and all patients with BCVI from 2009 to 2012 were analyzed. Patients undergoing WBCT scan were then identified, and records were reviewed for BCVI indicators (skull base fracture, cervical spine injury, displaced facial fracture, mandible fracture, Glasgow Coma Scale score ≤ 8, flexion mechanism, hard signs of neck vascular injury, or focal neurologic deficit).

RESULTS: Of 16,026 patients evaluated during the study period, 256 (1.6%) were diagnosed with BCVI. The population consisted of 185 patients with suspected BCVI after WBCT scan. One hundred twenty-nine patients (70%) had at least one indicator for BCVI screening, while 56 (30%) had no radiographic or clinical risk factors; 48 of the 56 patients underwent confirmatory CT angiography of the neck within 71 hours of initial WBCT scan, with 35 patients having 45 injuries.

CONCLUSION: More liberalized screening for BCVI during initial CT imaging in trauma patients clinically judged to have sufficient mechanism is warranted. Using current BCVI screening guidelines leads to missed BCVI and risk of stroke.

LEVEL OF EVIDENCE: Diagnostic study, level III.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
24553535
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"