Screening for blunt cerebrovascular injuries: the essential role of computed tomography angiography.
The implementation of aggressive diagnostics refuted the thesis that blunt cerebrovascular injuries (BCVI) are rare events. Given the estimates from recent studies, the prevalence may be as high as 1 per 100 among blunt multiple trauma patients. The morbidity and mortality of unrecognized and untreated BCVI is exceptionally high and warrants distinct efforts to detect these injuries during the primary trauma survey. The primary goal is to detect BCVI before neurological symptoms occur, and to introduce anticoagulation or antiplatelet therapy as appropriate. Index injuries such as cervical spine fractures increase the prior probability of disease, but are not helpful in ruling BCVI out. Computed tomography angiography (CTA) may represent the screening tool of choice, although there is still limited evidence about its accuracy. Pooled data from six studies (1368 patients) published between 2002 and 2006 suggest a sensitivity of 79% and a specificity of 97% in the trauma setting. In the two largest investigations, no false negative results were observed. Further research is needed to determine the efficacy of CTA for disclosing BCVI, and to evaluate the potential benefits to patients.
Stengel
Dirk
D
Center for Clinical Research, Unfallkrankenhaus Berlin Trauma Center, Berlin, Germany. stengeldirk@aol.com
Rademacher
Grit
G
Hanson
Beate
B
Ekkernkamp
Axel
A
Mutze
Sven
S
D001185:Artificial Intelligence; D002533:Cerebral Angiography; D020214:Cerebrovascular Trauma / Q000000981:diagnostic imaging* / Q000473:pathology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D006801:Humans; D015601:Injury Severity Score; D008403:Mass Screening; D012680:Sensitivity and Specificity; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000473:pathology