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Am J Surg. 2016 Dec;212(6):1167-1174. doi: 10.1016/j.amjsurg.2016.09.016. Epub 2016 Sep 29.

Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated.

Author information

1
Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
2
Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA. Electronic address: clay.cothren@dhha.org.

Abstract

BACKGROUND:

We implemented expanded screening criteria for blunt cerebrovascular injuries (BCVIs) in an attempt to capture the remaining 20% of patients not historically identified with earlier protocols. We hypothesized that these expanded criteria would capture the additional 20% of BCVI patients not previously identified.

METHODS:

Screening criteria for BCVI were expanded in 2011 after identifying new injury patterns. The study population included 4 years prior (2007 to 2010; classic) and following (2011 to 2014; expanded) implementation of expanded criteria.

RESULTS:

BCVIs were identified in 386 patients: 150 during the classic period (2.36% incidence) and 236 in the expanded period (2.99% incidence). In the expanded period, 155 patients were imaged based on classic screening criteria, 62 on expanded criteria (21 complex skull fractures, 20 upper rib fractures, 6 mandible fractures, 2 scalp degloving, 1 great vessel injury, and 12 combination), and 19 for other injuries and symptoms.

CONCLUSIONS:

There was a significant increase in the identification of BCVI following the adoption of expanded screening criteria, resulting in a substantial reduction of missed injuries. Expanded criteria should be adopted when screening for BCVI.

KEYWORDS:

Blunt cerebrovascular injuries; Carotid artery injury; Screening criteria; Stroke; Traumatic vascular injury; Vertebral artery injury

PMID:
27751528
DOI:
10.1016/j.amjsurg.2016.09.016
[Indexed for MEDLINE]

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