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Signs/Symptoms Risk Factors Potential arterial hemorrhage from face or neck High-energy trauma mechanism with: Cervical bruit in patient <50 yr LeFort II or III facial fracture Expanding cervical hematoma Mandible fracture Neurologic deficit inconsistent with head CT Complex skull or skull base fracture Stroke on CT or MRI Severe 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
Mechanism-Specific Risk Factors MVC Motorcycle/ATV Vehicle speed Vehicle speed Head-on collision Head-on collision Ejection No helmet Rollover No seat belt Air bags deployed Note:—ATV indicates all-terrain vehicle.
Trauma Mechanism No. % MVC 443 39.0 GLF 149 13.1 Fall down stairs 101 8.9 BA 93 8.2 MVC 88 7.8 Fall from higher than ground level 61 5.4 Penetrating injury 52 4.6 Pedestrian struck by motor vehicle 50 4.4 All-terrain vehicle or dirt bike 22 1.9 Hanging 8 0.7 Other 69 6.1 - Table 4:
Number of Biffl grade I–V injury assignments in patients with positive and indeterminate findings on neck CTAs
Group I II III IV V Positive studies 9 16 10 8 3 Indeterminate studies 114 6 1 3 0 TP 36 3 0 1 0 FP 78 3 1 2 0 Positive + TP 45 19 10 9 3
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