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Optimizing screening for blunt cerebrovascular injuries.

W L Biffl·E E Moore·P J Offner·K E Brega·R J Franciose·J P Elliott·J M Burch
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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.

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AdultCerebral AngiographyCerebrovascular TraumaFemaleHumansIncidenceLogistic ModelsMaleMass ScreeningRisk FactorsTrauma Severity IndicesWounds, NonpenetratingJournal Article

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W L Biffl, E E Moore, P J Offner, K E Brega, R J Franciose, J P Elliott, J M Burch. 1999. Optimizing screening for blunt cerebrovascular injuries.. https://doi.org/10.1016/s0002-9610(99)00245-7

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