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. 2021 Feb 1;90(2):224-231.
doi: 10.1097/TA.0000000000003010.

Universal screening for blunt cerebrovascular injury

Jonathan A Black  1 , Peter J Abraham, Mackenzie N Abraham, Daniel B Cox, Russell L Griffin, John B Holcomb, Parker J Hu, Jeffrey D Kerby, Elizabeth J Liptrap, Bart Thaci, Mark R Harrigan, Jan O Jansen
Affiliations

Universal screening for blunt cerebrovascular injury

Jonathan A Black et al. J Trauma Acute Care Surg. .

Abstract

Background: Blunt cerebrovascular injury (BCVI) can result in thromboembolic stroke. Many trauma centers selectively screen patients with cervical computed tomographic angiography (CTA) based on clinical criteria. In 2016, our institution adopted universal screening for BCVI for all blunt trauma patients. The aim of this study was to accurately determine the incidence of BCVI and to evaluate the diagnostic performance of the Denver criteria (DC), expanded Denver criteria (eDC), and Memphis criteria (MC) in selecting patients for screening.

Methods: Retrospective cohort study of adult (≥16 years) blunt trauma patients who presented to the Level I trauma center at University of Alabama at Birmingham. We reviewed all CTA reports and selected CTA images to obtain the true incidence rate of BCVI. We then evaluated the diagnostic performance of the DC, eDC, and MC.

Results: A total of 6,800 patients who had suffered blunt trauma were evaluated, of whom 6,287 (92.5%) had a neck CTA. Of these, 480 (7.6%) patients had CTA evidence of BCVI. The eDC identified the most BCVI cases (sensitivity 74.7%) but had the lowest positive predictive value (14.6%). The DC and MC had slightly greater positive predictive values (19.6% and 20.6%, respectively) and had the highest diagnostic ability in terms of likelihood ratio (2.8 and 2.9) but had low sensitivity (57.5% and 47.3%). Consequently, if relying on the traditional screening criteria, the DC, eDC, and MC would have respectively resulted in 42.5%, 25.3%, and 52.7% of patients with BCVI identified by universal screening not receiving a neck CTA to screen for BCVI.

Conclusion: Blunt cerebrovascular injury is even more common than previously thought. The diagnostic performance of selective clinical screening criteria is poor. Consideration should be given to the implementation of universal screening for BCVI using neck CTA in all blunt trauma patients.

Level of evidence: Diagnostic, level III.

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References

    1. Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg . 2020;88(6):875–887.
    1. Müther M, Sporns PB, Hanning U, Düsing H, Hartensuer R, Raschke M, Schwake M, Stummer W, Glasgow S. Diagnostic accuracy of different clinical screening criteria for blunt cerebrovascular injuries compared with liberal state of the art computed tomography angiography in major trauma. J Trauma Acute Care Surg . 2020;88:789–795.
    1. Sinnathamby M, Rao SV, Weber DG. Increased detection of blunt carotid and vertebral artery injury after implementation of diagnostic imaging pathway in level 1 trauma centre in Western Australia. Injury . 2017;48(9):1917–1921.
    1. Geddes AE, Burlew CC, Wagenaar AE, Biffl WL, Johnson JL, Pieracci FM, Campion EM, Moore EE. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. Am J Surg . 2016;212(6):1167–1174.
    1. Berne JD, Reuland KS, Villarreal DH, McGovern TM, Rowe SA, Norwood SH. Sixteen-slice multi-detector computed tomographic angiography improves the accuracy of screening for blunt cerebrovascular injury. J Trauma . 2006;60(6):1204–1209; discussion 1209-10.

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