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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleEmergency Neuroradiology

Blunt Cerebrovascular Injury: Are We Overscreening Low-Mechanism Trauma?

Kevin D. Hiatt, Raghav Agarwal, Chesney S. Oravec, Erica C. Johnson, Nishk P. Patel, Carol P. Geer, Stacey Q. Wolfe and Michael E. Zapadka
American Journal of Neuroradiology November 2023, 44 (11) 1296-1301; DOI: https://doi.org/10.3174/ajnr.A8004
Kevin D. Hiatt
aFrom the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina
bDepartment of Radiology (K.D.H., C.P.G., S.Q.W., M.E.Z.), Atrium Health Wake Forest Baptist
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  • ORCID record for Kevin D. Hiatt
Raghav Agarwal
aFrom the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina
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Chesney S. Oravec
aFrom the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina
cDepartment of Neurological Surgery (C.S.O., S.Q.W.), Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Erica C. Johnson
dDepartment of General Surgery (E.C.J.), Virginia Commonwealth University Health, Richmond, Virginia.
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Nishk P. Patel
aFrom the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina
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  • ORCID record for Nishk P. Patel
Carol P. Geer
aFrom the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina
bDepartment of Radiology (K.D.H., C.P.G., S.Q.W., M.E.Z.), Atrium Health Wake Forest Baptist
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  • ORCID record for Carol P. Geer
Stacey Q. Wolfe
aFrom the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina
bDepartment of Radiology (K.D.H., C.P.G., S.Q.W., M.E.Z.), Atrium Health Wake Forest Baptist
cDepartment of Neurological Surgery (C.S.O., S.Q.W.), Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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  • ORCID record for Stacey Q. Wolfe
Michael E. Zapadka
aFrom the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina
bDepartment of Radiology (K.D.H., C.P.G., S.Q.W., M.E.Z.), Atrium Health Wake Forest Baptist
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Article Figures & Data

Tables

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    Table 1:

    The expanded Denver criteriaa

    Signs/SymptomsRisk Factors
    Potential arterial hemorrhage from face or neckHigh-energy trauma mechanism with:
    Cervical bruit in patient <50 yrLeFort II or III facial fracture
    Expanding cervical hematomaMandible fracture
    Neurologic deficit inconsistent with head CTComplex skull or skull base fracture
    Stroke on CT or MRISevere TBI with GCS < 6
    Cervical spine fracture, subluxation, or ligamentous injury at any level
    Near hanging with anoxic brain injury
    Clothesline type injury or seat belt abrasion with significant swelling, pain, or altered mental status
    TBI with thoracic injuries
    Scalp degloving
    Thoracic vascular injury
    Blunt cardiac rupture
    Upper rib fractures
    • Note:—TBI indicates traumatic brain injury; GCS, Glasgow Coma Scale.

    • ↵a Adapted from Nagpal et al.37

    • View popup
    Table 2:

    Additional clinical risk factors recorded specific to trauma mechanism

    Mechanism-Specific Risk Factors
    MVCMotorcycle/ATV
    Vehicle speedVehicle speed
    Head-on collisionHead-on collision
    EjectionNo helmet
    Rollover
    No seat belt
    Air bags deployed
    • Note:—ATV indicates all-terrain vehicle.

    • View popup
    Table 3.

    Classification of trauma mechanisms

    Trauma MechanismNo.%
    MVC44339.0
    GLF14913.1
    Fall down stairs1018.9
    BA938.2
    MVC887.8
    Fall from higher than ground level615.4
    Penetrating injury524.6
    Pedestrian struck by motor vehicle504.4
    All-terrain vehicle or dirt bike221.9
    Hanging80.7
    Other696.1
    • View popup
    Table 4:

    Number of Biffl grade I–V injury assignments in patients with positive and indeterminate findings on neck CTAs

    GroupIIIIIIIVV
    Positive studies9161083
    Indeterminate studies1146130
     TP363010
     FP783120
    Positive + TP45191093
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American Journal of Neuroradiology: 44 (11)
American Journal of Neuroradiology
Vol. 44, Issue 11
1 Nov 2023
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Cite this article
Kevin D. Hiatt, Raghav Agarwal, Chesney S. Oravec, Erica C. Johnson, Nishk P. Patel, Carol P. Geer, Stacey Q. Wolfe, Michael E. Zapadka
Blunt Cerebrovascular Injury: Are We Overscreening Low-Mechanism Trauma?
American Journal of Neuroradiology Nov 2023, 44 (11) 1296-1301; DOI: 10.3174/ajnr.A8004

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Blunt Cerebrovascular Injury: Screening Practices
Kevin D. Hiatt, Raghav Agarwal, Chesney S. Oravec, Erica C. Johnson, Nishk P. Patel, Carol P. Geer, Stacey Q. Wolfe, Michael E. Zapadka
American Journal of Neuroradiology Nov 2023, 44 (11) 1296-1301; DOI: 10.3174/ajnr.A8004
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  • Author reply: Letter to the Editor regarding “Blunt cerebrovascular injury: The case for universal screening”
    Stefan W. Leichtle, Sudha Jayaraman, Edgar B. Rodas, Michel B. Aboutanos
    Journal of Trauma and Acute Care Surgery 2025 98 2

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