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

Article Figures & Data

Tables

  • 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

  • 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.

  • 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
  • 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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