Improving the screening criteria for blunt cerebrovascular injury

The appropriate role for computed tomography angiography

Katrina P. Emmett, Timothy Fabian, Jennifer M. Dicocco, Ben L. Zarzaur, Martin Croce

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: Screening criteria and diagnostic methods for blunt cerebrovascular injury (BCVI) are evolving. Using current screening guidelines, up to 20% of injuries are not recognized until symptoms occur, and thus missing the therapeutic window. All patients who meet screening criteria at our institution undergo angiography due to conflicting sensitivity data reported for computed tomographic angiography (CTA). We sought to refine screening criteria for BCVI to optimize patient care. Methods: All trauma admissions screened for BCVI over a 29-month period ending May 2009 were analyzed. Thirty-two channel CTA was obtained during initial radiologic evaluation. Patients underwent angiography for conventional screening criteria or abnormal CTA. Demographics, criteria for BCVI screening, fracture patterns, associated injuries, and results of CTA and angiography were analyzed. Results: A total of 748 patients were screened, 143 injuries (78 carotid and 65 vertebral) were diagnosed in 117 patients (16%). Nineteen of the 117 patients (16%) with BCVI had no conventional criteria and were only screened for CTA abnormalities. One patient developed neurologic symptoms subsequent to initial evaluation with no conventional screening criteria or CTA findings. The conventional screening criteria identify most patients with BCVI (84%). CTA as a screening criterion captures nearly all remaining patients before symptoms developing. This allows for detection and treatment of injuries in patients that otherwise would be missed until symptomatic. CTA should be part of the radiologic evaluation for potential head, neck, and facial injuries. Unfortunately, CTA is not sensitive enough to reliably detect injuries, but should be added as a screening criterion. Angiography remains the gold standard for BCVI diagnosis.

Original languageEnglish (US)
Pages (from-to)1058-1065
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume70
Issue number5
DOIs
StatePublished - May 1 2011

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Nonpenetrating Wounds
Angiography
Wounds and Injuries
Computed Tomography Angiography
Facial Injuries
Neck Injuries
Neurologic Manifestations
Craniocerebral Trauma
Patient Care

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

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Improving the screening criteria for blunt cerebrovascular injury : The appropriate role for computed tomography angiography. / Emmett, Katrina P.; Fabian, Timothy; Dicocco, Jennifer M.; Zarzaur, Ben L.; Croce, Martin.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 70, No. 5, 01.05.2011, p. 1058-1065.

Research output: Contribution to journalArticle

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