Blunt cerebrovascular injury in trauma patients: an under-recognised injury pattern at Auckland City Hospital

Blunt cerebrovascular injury (BCVI) is a rare but potentially devastating injury that can lead to stroke and death without early diagnosis and treatment. Evidence-based practice guidelines recommend screening at-risk patients with neck computed tomographic angiography (CTA). We sought to evaluate the efficacy of such a screening protocol at a high-volume trauma centre in Aotearoa New Zealand.

A retrospective chart review was conducted of adult blunt trauma patients who presented to our trauma centre from March to August 2023 who had injuries that met criteria for screening. Adherence to protocol as determined by capture of neck CTA within 6 hours of admission, incidence of BCVI, stroke and death were collected.

Ninety-five patients met criteria to screen for BCVI; only 41 (43%) underwent screening CTA. BCVI incidence was 6/41 (14.6%). Of the 54 patients not screened, there was one BCVI that progressed to stroke. Overall BCVI rate is estimated at 2.4%; an additional seven BCVIs may have been present.

BCVI is more common than previously recognised in blunt trauma patients. Increased awareness of BCVI screening protocols and systematic screening systems to facilitate early identification and treatment should be implemented to diminish the incidence of missed injury and devastating sequela.