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Updated: Nov 19, 2025
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Universal screening for blunt cerebrovascular injury
Jonathan A Black1, Peter J Abraham, Mackenzie N Abraham
1From the Division of Acute Care Surgery, Department of Surgery, (J.A.B, D.B.C., J.B.H., P.J.H., J.D.K., J.O.J.); Department of Surgery (P.J.A., M.N.A.), School of Public Health (R.L.G.), Department of Neurosurgery (E.J.L., M.R.H.), and Department of Radiology (B.T.), University of Alabama at Birmingham, Birmingham, Alabama.
Universal screening for blunt cerebrovascular injury (BCVI) using neck CTA is more effective than selective criteria. This approach identifies more BCVI cases, reducing the risk of missed diagnoses and potential thromboembolic stroke in blunt trauma patients.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Diagnostic Imaging
Background:
- Blunt cerebrovascular injury (BCVI) can lead to thromboembolic stroke.
- Many trauma centers use selective screening with cervical computed tomographic angiography (CTA) based on clinical criteria.
- Universal screening for BCVI was implemented at our institution in 2016.
Purpose of the Study:
- Determine the true incidence of BCVI in blunt trauma patients.
- Evaluate the diagnostic performance of Denver Criteria (DC), expanded Denver Criteria (eDC), and Memphis Criteria (MC) for BCVI screening.
Main Methods:
- Retrospective cohort study of adult blunt trauma patients (≥16 years) at a Level I trauma center.
- Reviewed CTA reports and images to establish BCVI incidence.
- Assessed the diagnostic accuracy of DC, eDC, and MC.
Main Results:
- Out of 6,800 blunt trauma patients, 6,287 underwent neck CTA, revealing a BCVI incidence of 7.6% (480 patients).
- Expanded Denver Criteria (eDC) showed the highest sensitivity (74.7%) but lowest positive predictive value (14.6%).
- Denver Criteria (DC) and Memphis Criteria (MC) had higher positive predictive values (19.6%, 20.6%) but lower sensitivity (57.5%, 47.3%).
- Selective criteria (DC, eDC, MC) would have missed 42.5%, 25.3%, and 52.7% of BCVI cases, respectively.
Conclusions:
- Blunt cerebrovascular injury is more prevalent than previously recognized.
- Selective clinical screening criteria demonstrate poor diagnostic performance for BCVI.
- Universal screening for BCVI using neck CTA in all blunt trauma patients warrants consideration.
