Blunt cerebrovascular injury screening guidelines

• DOI: 10.1097/ta.0b013e3182ab1b4d
• Publication Date: 2014-02-19T12:29:48Z
• Authors: Brandon Robert Bruns; Ronald Tesoriero; Joseph Kufera; Clint Sliker; Adriana Laser; Thomas M. Scalea; Deborah M. Stein
• Keywords: Blunt trauma

Blunt cerebrovascular injury (BCVI) is reported to occur in approximately 2% of blunt trauma patients, with a stroke rate up 20%. Guidelines for BCVI screening are based on clinical and radiographic findings. We hypothesized that liberal the neck vasculature, as part initial computed tomographic (CT) imaging patients significant mechanisms injury, identifies may go undetected.As per protocol, at risk injuries undergo noncontrast head CT scan followed by multislice (40-slice or 64-slice) incorporating an intravenous contrast-enhanced pass from circle Willis through pelvis (whole-body [WBCT] scan). The registry was retrospectively reviewed, all 2009 2012 were analyzed. Patients undergoing WBCT then identified, records reviewed indicators (skull base fracture, cervical spine displaced facial mandible Glasgow Coma Scale score ≤ 8, flexion mechanism, hard signs vascular focal neurologic deficit).Of 16,026 evaluated during study period, 256 (1.6%) diagnosed BCVI. population consisted 185 suspected after scan. One hundred twenty-nine (70%) had least one indicator screening, while 56 (30%) no factors; 48 underwent confirmatory angiography within 71 hours scan, 35 having 45 injuries.More liberalized clinically judged have sufficient mechanism warranted. Using current guidelines leads missed stroke.Diagnostic study, level III.