Southwestern Surgical CongressExpanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated
Section snippets
Methods
Screening protocols for BCVI based on injury mechanism, injury patterns, or symptoms have been used at Denver Health Medical center, a state-certified and American College of Surgeons–verified Level I regional trauma center since 1996. In 2011, we implemented expanded screening criteria based on our prior analysis in an effort to identify BCVI in patients while they were asymptomatic. To compare a preimplementation period to a postimplementation period, we analyzed the 4 years (2007 to 2010)
Results
During the 8-year study period, 386 patients with BCVIs were identified out of 14,270 blunt trauma admissions. The mean age of the patient population was 39 ± .9 years (range 2 to 85 years) and the majority (61%) was men. Of the 386 patients with identified BCVIs, 346 (90%) were asymptomatic, whereas 40 had signs of stroke or cerebral ischemia. There were 161 patients with carotid artery injuries (CAIs), 165 patients with vertebral artery injuries (VAI), and 60 patients with combined CAI and
Comments
Prevention of BCVI-related stroke has been vigorously pursued for the past 2 decades. Aggressive screening protocols and the early institution of antithrombotic therapy has reduced the BCVI-related stroke rate from 20% to less than 1% in patients receiving treatment.11, 21 With the advent of reliable noninvasive imaging modalities to diagnose BCVI,2, 3, 4, 5, 6, 7, 8 expanded screening protocols have been advocated in an attempt to capture the vast majority of BCVI patients during their
Conclusions
In our experience, adoption of the expanded screening criteria for BCVI captured the majority of the historically identified 20% of BCVI that are difficult to identify. In addition, implementing the expanded criteria increased our overall identification of BCVI beyond what was expected. With expanded criteria, the incidence of BCVI approaches 3% of all blunt trauma admissions. Currently, one-quarter of all patients diagnosed with BCVI are identified solely with the new screening indications:
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The authors declare no conflicts of interest.