Clinical utility of a screening protocol for blunt cerebrovascular injury using computed tomography angiography
Adult
Male
Computed Tomography Angiography
Middle Aged
Wounds, Nonpenetrating
Brain Ischemia
Cerebral Angiography
3. Good health
Stroke
03 medical and health sciences
0302 clinical medicine
Clinical Protocols
Humans
Female
Cerebrovascular Trauma
Prospective Studies
Retrospective Studies
DOI:
10.3171/2016.1.jns151545
Publication Date:
2016-04-22T14:00:49Z
AUTHORS (7)
ABSTRACT
OBJECTIVE
Blunt cerebrovascular injury (BCVI) occurs in approximately 1% of the blunt trauma population and may lead to stroke and death. Early vascular imaging in asymptomatic patients at high risk of having BCVI may lead to earlier diagnosis and possible stroke prevention. The objective of this study was to determine if the implementation of a formalized asymptomatic BCVI screening protocol with CT angiography (CTA) would lead to improved BCVI detection and stroke prevention.
METHODS
Patients with vascular imaging studies were identified from a prospective trauma registry at a single Level 1 trauma center between 2002 and 2008. Detection of BCVI and stroke rates were compared during the 3-year periods before and after implementation of a consensus-based asymptomatic BCVI screening protocol using CTA in 2005.
RESULTS
A total of 5480 patients with trauma were identified. The overall BCVI detection rate remained unchanged postprotocol compared with preprotocol (0.8% [24 of 3049 patients] vs 0.9% [23 of 2431 patients]; p = 0.53). However, postprotocol there was a trend toward a decreased risk of stroke secondary to BCVI on a trauma population basis (0.23% [7 of 3049 patients] vs 0.53% [13 of 2431 patients]; p = 0.06). Overall, 75% (35 of 47) of patients with BCVI were treated with antiplatelet agents, but no patient developed new or progressive intracranial hemorrhage despite 70% of these patients having concomitant traumatic brain injury.
CONCLUSIONS
The results of this study suggest that a CTA screening protocol for BCVI may be of clinical benefit with possible reduction in ischemic complications. The treatment of BCVI with antiplatelet agents appears to be safe.
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