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Research ArticleEXTRACRANIAL VASCULAR

Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis

A. Malhotra, X. Wu, V.B. Kalra, J. Schindler, C.C. Matouk and H.P. Forman
American Journal of Neuroradiology February 2016, 37 (2) 330-335; DOI: https://doi.org/10.3174/ajnr.A4515
A. Malhotra
aFrom the Departments of Diagnostic Radiology (A.M., X.W., V.B.K., C.C.M., H.P.F.)
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  • ORCID record for A. Malhotra
X. Wu
aFrom the Departments of Diagnostic Radiology (A.M., X.W., V.B.K., C.C.M., H.P.F.)
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V.B. Kalra
aFrom the Departments of Diagnostic Radiology (A.M., X.W., V.B.K., C.C.M., H.P.F.)
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J. Schindler
bNeurology (J.S.)
cNeurosurgery (J.S., C.C.M.), Yale School of Medicine, New Haven, Connecticut.
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C.C. Matouk
aFrom the Departments of Diagnostic Radiology (A.M., X.W., V.B.K., C.C.M., H.P.F.)
cNeurosurgery (J.S., C.C.M.), Yale School of Medicine, New Haven, Connecticut.
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H.P. Forman
aFrom the Departments of Diagnostic Radiology (A.M., X.W., V.B.K., C.C.M., H.P.F.)
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    Fig 1.

    Flow chart of the simplified model. VAI indicates vertebral artery injury; CAI, carotid artery injury.

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    Fig 2.

    Scatterplot of incremental cost (cost of selective DSA and cost of selective CTA) versus incremental effectiveness (effectiveness of selective DSA and effectiveness of selective CTA). The incremental effectiveness in all iterations was negative (selective DSA has worse outcomes), and the incremental costs were positive (selective DSA is more expensive), suggesting that selective DSA is less cost-effective than selective CTA.

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    Table 1:

    BCVI screening criteria

    Signs and symptomsArterial hemorrhage/expanding cervical hematoma
    Cervical bruit
    Focal neurologic deficit
    Neurologic examination incongruous with head CT scan findings
    Stroke on secondary CT scan
    Risk factorsMaxillo facial fractures–Le Fort II or III fracture
    Cervical spine fracture patterns: extension into the transverse foramen, C1–C3 vertebral fractures
    Skull base fracture extending to involve the carotid canal
    Diffuse axonal injury with GCS score <6
    Near hanging with anoxic brain injury
    • Note:—GCS indicates Glasgow Coma Scale. Table adapted from Cothren et al.34

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    Table 2:

    Base case calculation results

    StrategyCost ($)Effectiveness (QALY)
    Selective anticoagulation21.080.7231074
    Selective CTA48.840.7229382
    Selective DSA284.620.7228022
    CTA for all419.110.7229337
    DSA for all5594.160.7196092
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American Journal of Neuroradiology: 37 (2)
American Journal of Neuroradiology
Vol. 37, Issue 2
1 Feb 2016
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Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis
A. Malhotra, X. Wu, V.B. Kalra, J. Schindler, C.C. Matouk, H.P. Forman
American Journal of Neuroradiology Feb 2016, 37 (2) 330-335; DOI: 10.3174/ajnr.A4515

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Evaluation for Blunt Cerebrovascular Injury: Review of the Literature and a Cost-Effectiveness Analysis
A. Malhotra, X. Wu, V.B. Kalra, J. Schindler, C.C. Matouk, H.P. Forman
American Journal of Neuroradiology Feb 2016, 37 (2) 330-335; DOI: 10.3174/ajnr.A4515
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