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Blunt Cerebrovascular Injury: Are We Overscreening Low-Mechanism Trauma?
Kevin D Hiatt1,2, Raghav Agarwal3, Chesney S Oravec3,4
1From the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina kehiatt@wakehealth.edu.
AJNR. American Journal of Neuroradiology
|October 12, 2023
Summary
Screening low-mechanism trauma patients for blunt cerebrovascular injury using neck CTA is often unnecessary. Excluding patients not meeting expanded Denver criteria could prevent false positives without missing injuries.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Emergency Medicine
- Radiology
Background:
- Blunt cerebrovascular injury (BCVI) screening in trauma patients is common but controversial.
- Disagreement exists on appropriate screening criteria, especially for low-mechanism trauma.
Purpose of the Study:
- To evaluate the necessity of screening low-mechanism trauma patients for BCVI.
- To determine if current screening practices are warranted in this patient subset.
Main Methods:
- Retrospective review of adult trauma patients undergoing neck CTA at a Level 1 trauma center.
- Analysis of clinical and imaging risk factors, trauma mechanisms, CTA interpretations, and outcomes.
- Inclusion of subsequent CTA/DSA findings and treatment data.
Main Results:
- Of 1136 neck CTAs, 4% were positive for BCVI.
- In low-mechanism trauma cases not meeting expanded Denver criteria, screening could have been avoided with 0 missed ischemic strokes and 12 false positives prevented.
- BCVI was identified in 12.6% of cases meeting and 1.7% not meeting expanded Denver criteria.
Conclusions:
- BCVI screening in low-mechanism trauma should be reserved for patients meeting expanded Denver criteria.
- Further research is needed to clarify indeterminate findings and differentiate true from false positives.
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