Scientific Papers
Optimizing screening for blunt cerebrovascular injuries

Presented at the 51st Annual Meeting of the Southwestern Surgical Congress, Coronado, California, April 18–21, 1999.
https://doi.org/10.1016/S0002-9610(99)00245-7Get rights and content

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 ≤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.

Section snippets

Patients

Denver Health Medical Center is a certified urban level I trauma center with pediatric commitment, and serves as the Rocky Mountain regional trauma center for Colorado and adjoining regions. The number of trauma admissions during the study period (January 1990 through September 1998) has been stable at 3000 to 3200 patients per year, and 86% of admissions have resulted from blunt injury. Our trauma registry records patients at the time of their hospitalization, and was employed to identify

Patients

From January 1990 through September 1998, cerebral arteriography was performed in 249 patients to exclude BCVI; 85 (34%) were diagnosed with injuries. Sixty-five patients had carotid injuries, 10 had vertebral injuries, and 10 had both carotid and vertebral injuries. Carotid injuries were bilateral in 32 patients, and vertebral injuries bilateral in 5. Forty patients initially presented with signs or symptoms of BCVI; 28 (70%) had injuries. Among 209 asymptomatic patients, we diagnosed injuries

Comments

Blunt cerebrovascular injuries (BCVI) have the potential for devastating complications. Early reports collectively established mortality rates of BCI to be 28%, with 58% of survivors suffering severe neurologic sequelae.1, 2, 3 Subsequent multicenter reviews corroborated these disconcerting morbidity and mortality figures, and identified the incidence of BCI to be 0.08% to 0.17% among patients admitted to trauma centers following blunt injury.4, 5, 6, 7 Based on our involvement in one such

References (20)

  • R.F. Martin et al.

    Blunt trauma to the carotid arteries

    J Vasc Surg

    (1991)
  • F. Ramadan et al.

    Carotid artery traumaa review of contemporary trauma center experiences

    J Vasc Surg

    (1995)
  • S. Yamada et al.

    Carotid artery occlusion due to nonpenetrating injury

    J Trauma

    (1967)
  • L.P. Krajewski et al.

    Blunt carotid artery traumareport of two cases and review of the literature

    Ann Surg

    (1980)
  • M.O. Perry et al.

    Carotid artery injuries caused by blunt trauma

    Ann Surg

    (1980)
  • J.W. Davis et al.

    Blunt carotid artery dissectionincidence, associated injuries, screening, and treatment

    J Trauma

    (1990)
  • T.H. Cogbill et al.

    The spectrum of blunt injury to the carotid arterya multicenter perspective

    J Trauma

    (1994)
  • T.C. Fabian et al.

    Blunt carotid injuryimportance of early diagnosis and anticoagulant therapy

    Ann Surg

    (1996)
  • J.A. Prall et al.

    Incidence of unsuspected blunt carotid artery injury

    Neurosurgery

    (1998)
  • B. Mokri et al.

    Traumatic dissections of the extracranial internal carotid artery

    J Neurosurg

    (1988)
There are more references available in the full text version of this article.

Cited by (243)

  • Association of craniomaxillofacial fractures and blunt cerebrovascular injuries

    2023, International Journal of Oral and Maxillofacial Surgery
  • Cerebrovascular injuries in traumatic brain injury

    2022, Clinical Neurology and Neurosurgery
View all citing articles on Scopus
View full text