Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke

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Bensch , F , Varjonen , E A , Pyhältö , T T & Koskinen , S K 2019 , ' Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke ' , Emergency Radiology , vol. 26 , no. 4 , pp. 365-372 . https://doi.org/10.1007/s10140-019-01677-0

Title: Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke
Author: Bensch, Frank; Varjonen, Elina A.; Pyhältö, Tuomo T.; Koskinen, Seppo K.
Contributor: University of Helsinki, HUS Medical Imaging Center
University of Helsinki, HUS Medical Imaging Center
University of Helsinki, HUS Musculoskeletal and Plastic Surgery
Date: 2019-08
Language: eng
Number of pages: 8
Belongs to series: Emergency Radiology
ISSN: 1070-3004
URI: http://hdl.handle.net/10138/306023
Abstract: Purpose BCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke. Methods Denver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT angiography (CTA) over a period of 38 months were reviewed retrospectively by two Fellowship-trained radiologists, as well as any cerebral imaging after the initial trauma. Results 1544 WBCT studies included 374 CTA (m/f = 271/103; mean age 41.5 years). Most common mechanisms of injury were MVA (51.5%) and fall from a height (22.3%). We found 72 BCVI in 56 patients (15.0%), with 13 (23.2%) multiple lesions. The ICA was affected in 49 (68.1%) and the vertebral artery in 23 (31.9%) of cases. The most common injury level was C2, with Biffl grades I and II most common in ICA, and II and IV in VA. Interobserver agreement was substantial (Kappa = 0.674). Of 215 patients imaged, 16.1% with BCVI and 1.9% of the remaining cases had cerebral ischemic stroke (p <.0001; OR = 9.77; 95% CI 3.3-28.7). Eleven percent of patients with BCVI would not have met standard screening criteria. Conclusions The increase in detection rate for BCVI justifies more liberal screening protocols.
Subject: BCVI
Cerebrovascular injury
CT angiography
Screening
Trauma
Ischemic stroke
BLUNT CEREBROVASCULAR INJURY
COMPUTED TOMOGRAPHIC ANGIOGRAPHY
DIAGNOSIS
ASSOCIATION
GUIDELINES
MANAGEMENT
THERAPY
3126 Surgery, anesthesiology, intensive care, radiology
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