CT Angiographic Screening for Blunt Cerebrovascular Injury: Increased Utilization After Inclusion of Strangulation...

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Diagnostic Imaging

Background:

• Blunt cerebrovascular injury (BCVI) screening guidelines have evolved since the 1990s.
• Anecdotal increase in CT angiography (CTA) for BCVI, especially with strangulation, prompted this study.

Purpose of the Study:

• To evaluate the impact of progressively expanded BCVI screening criteria on CTA utilization.
• To assess BCVI detection rates with evolving screening criteria at an academic institution.

Main Methods:

• Retrospective review of CTA studies for BCVI at Denver Health (July-August 2024).
• Analysis of patient charts for risk factors based on Denver BCVI Criteria (2012, 2016, 2020).
• Variables included BCVI status, mechanism of injury, and demographics.

Main Results:

• Of 253 patients, 17.0% had BCVI. The 2020 criteria captured 93.7% of screened patients.
• Strangulation was the most common indication (24.9%), but had a low BCVI detection rate (0-1.6%).
• BCVI detection rates were similar between 2016 and 2020 criteria, despite the inclusion of strangulation.

Conclusions:

• Expanded BCVI screening criteria identify more patients, but strangulation as an indication does not improve BCVI detection.
• Current data suggest many strangulation patients may not require CTA screening.
• Development of evidence-based screening criteria for BCVI in strangulation is crucial.