Optimizing screening for blunt cerebrovascular injuries

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 less than or equal to 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, Am J Surg. 1999;178:517-522. (C) 1999 by Excerpta Medica, Inc.