Above the Clavicle: A Simplified Screening Method for Asymptomatic Blunt Cerebral Vascular Injury

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Emergency Medicine

Background:

• Blunt cerebrovascular injury (BCVI) is a significant cause of morbidity and stroke in trauma patients.
• Current screening protocols for BCVI using CT angiography of the neck (CTAN) are complex.
• Early identification and treatment of BCVI can reduce stroke incidence.

Purpose of the Study:

• To evaluate an expanded and simplified method for identifying patients with clinical suspicion for BCVI.
• To assess the utility of injury above the clavicle (ATC) as a screening criterion for BCVI.
• To identify a previously undiagnosed cohort of BCVI patients.

Main Methods:

• Retrospective review of adult blunt trauma patients diagnosed with BCVI from 2010-2019.
• Patients undergoing CTAN were divided into groups based on expanded Denver criteria or clinical evidence of any injury ATC.
• Analysis of injury patterns and diagnostic yield between the two screening groups.

Main Results:

• 219 patients diagnosed with BCVI (0.9% incidence).
• 17 patients (8%) diagnosed with BCVI met the ATC criteria but not the expanded Denver criteria.
• Facial trauma was the most common reason for CTAN in the ATC group.
• No significant differences in carotid artery injuries (CAI) or vertebral artery injuries (VAI) distribution between groups.

Conclusions:

• Screening for blunt trauma with any injury above the clavicle (ATC) is a simple and effective method.
• The ATC criterion can identify BCVI patients missed by current protocols.
• Integrating ATC screening with initial whole-body imaging may improve BCVI detection rates.