Evaluating Blunt Cerebrovascular Injury Screening in High-Energy Trauma Patients: A Rural Trauma Center Study.

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Emergency Medicine

Background:

• Blunt cerebrovascular injury (BCVI) is a rare but serious complication of blunt trauma.
• Current screening guidelines like the expanded Denver Criteria (eDC) may miss up to 20% of BCVI cases.
• A rural Level 1 trauma center implemented a high-energy mechanism (HEM) protocol to screen all blunt trauma patients.

Purpose of the Study:

• To evaluate the diagnostic performance of the HEM protocol compared to the eDC for BCVI detection.
• To assess the impact of the HEM protocol on BCVI detection rates and stroke incidence.
• To determine if the HEM protocol reduces missed BCVI cases.

Main Methods:

• A two-phase cohort study at a rural Level I trauma center.
• Retrospective preimplementation phase (May 2020-May 2022) using eDC.
• Prospective postimplementation phase (August 2023-August 2024) using the HEM protocol.
• Comparison of detected BCVI rates and stroke incidences between the two phases.

Main Results:

• The HEM protocol demonstrated higher sensitivity (94.9% vs. 76.9%) for BCVI detection compared to eDC in the preimplementation phase.
• In the postimplementation phase, the HEM protocol achieved 100% sensitivity.
• The HEM protocol decreased missed BCVI cases compared to eDC screening.
• Stroke incidence remained low (0.2%) and did not significantly change between phases.

Conclusions:

• The HEM protocol is more sensitive for detecting BCVI in blunt trauma patients than the eDC.
• Liberalized BCVI screening using the HEM protocol in blunt trauma patients with high-energy mechanisms is recommended for rural trauma settings.
• Larger studies are needed to determine the impact of earlier BCVI identification on stroke outcomes.