Incidental findings identified by universal screening for BCVI using CT angiography

Blunt cerebrovascular injuries (BCVIs) are injuries to the carotid or vertebral arteries resulting from blunt trauma. Screening for BCVI is done using neck computed tomographic angiography (CTA). Although several screening protocols have been developed, many institutions, including our regional Level 1 trauma center, have implemented universal screening protocols to ensure no injuries are missed. When screening for acute injuries, incidental findings (IFs) may be discovered as a result. The aim of this study is to determine the incidence of IFs discovered with universal screening for BCVI.

Priority 1 and 2 adult (≥ 18) blunt trauma patients presenting between April 2023 and April 2024 were identified from our trauma registry. Medical records were retrospectively reviewed to identify the incidence of IFs in patients screened for BCVI.

A total of 1,832 eligible blunt trauma patients were evaluated, of whom 1,554 (84.83%) underwent screening with neck CTA. Of these, 58 patients (3.73%) had CTA evidence of BCVI, 20 (34.48%) of whom had no risk factors based on the expanded Denver criteria. A total of 265 IFs were discovered in 224 patients (14.55%). Included in these IFs were chronic arterial occlusions (n = 27), aneurysms (n = 9), moderate-severe stenoses (n = 139), and significant thyroid nodules (n = 26). Eighty-one patients (36.16%) were discharged yet had no evidence in their records that they were informed of these incidental findings.

IFs are identified in a significant percentage of blunt trauma patients with universal screening for BCVI. Trauma centers using universal screening for BCVI must have protocols in place for informing patients of IFs to ensure proper follow-up care is obtained for these patients.