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Am J Surg. 1999 Dec;178(6):517-22.

Optimizing screening for blunt cerebrovascular injuries.

Author information

1
Department of Surgery, Denver Health Medical Center and University of Colorado Health Sciences Center, 80204-4507, USA.

Abstract

BACKGROUND:

The recognition that early diagnosis and intervention, prior to ischemic neurologic injury, has the potential to improve outcome following blunt cerebrovascular injuries (BCVI), led to a policy of aggressive screening for these injuries. The resultant epidemic of BCVI has created a dilemma, as widespread screening is impractical. We sought to identify independent predictors of BCVI, to focus resources.

METHODS:

Cerebral arteriography was performed based on signs or symptoms of BCVI, or in asymptomatic patients with high-risk mechanisms (hyperextension, hyperflexion, direct blow) or injury patterns. Logistic regression analysis identified independent predictors.

RESULTS:

A total of 249 patients underwent arteriography; 85 (34%) had injuries. Independent predictors of carotid arterial injury were Glasgow coma score < or =6, petrous bone fracture, diffuse axonal brain injury, and LeFort II or III fracture. Having one of these factors in the setting of a high-risk mechanism was associated with 41% risk of injury. Of patients with cervical spine fracture, 39% had vertebral arterial injury.

CONCLUSIONS:

Patients sustaining high-risk injury mechanisms or patterns should be screened for BCVI. In the face of limited resources, screening efforts should be focused on those with high-risk predictors.

PMID:
10670864
DOI:
10.1016/s0002-9610(99)00245-7
[Indexed for MEDLINE]

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