title: Blunt cerebrovascular injuries in acute trauma care: a screening protocol.
abstract: BACKGROUND
  Blunt cerebrovascular injuries (BCVI) of the extra- or intracerebral vessels are frequently observed lesions which may lead to thrombembolic events with focal neurological deficits, stroke or death particularly in patients <60 years. However, a comprehensive standardised clinical algorithm for screening and management of these secondary injuries is still lacking.
  
  
  METHODS
  We developed a standardised screening protocol applicable for mild as well as severely injured patients. In this prospective cohort study, we evaluated the feasibility of this diagnostic algorithm in a level 1 trauma centre setting. Trauma patients who met the inclusion criteria underwent a computed tomographic angiography (CTA) as part of standard diagnostic procedure at admission. All suspicions or positive findings were reevaluated by a conventional four-vessel catheter angiography within the first 72 h after trauma. Within this period, anticoagulation with low-dose heparin was started. BCVI confirmation indicated a shift to systemic heparinisation with overlapping phenprocoumon therapy for at least 6 months. All patients were reevaluated after 6 months by another four-vessel angiography. Depending on the diagnostic findings, oral anticoagulation may be discontinued or continued for another 6 months.
  
  
  RESULTS
  A total of 44 patients (8 male, 6 female, age range 19-95 years) were included in the study. 20 BCVIs were detected in 16 patients (36.3%). The most common injuries identified were Biffl Type II (40%) and Type IV lesions (30%). 86.4% of the patients received a CTA upon admission, 93.2% of which were conducted within 12 h posttrauma. None of the patients had a secondary thrombembolic neurological event during the hospital stay or within 3 months postdischarge.
  
  
  CONCLUSIONS
  Our results indicate that implementation of the screening protocol can prevent strokes in patients without primary thrombembolic neurological deficits.
authors: Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Waldeyerstr. 1, 48161 Münster, Germany.
authors: L
authors: L
authors: Löhrer
authors: V
authors: V
authors: Vieth
authors: I
authors: I
authors: Nassenstein
authors: R
authors: R
authors: Hartensuer
authors: T
authors: T
authors: Niederstadt
authors: M J
authors: MJ
authors: Raschke
authors: T
authors: T
authors: Vordemvenne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015331:Cohort Studies; D003422:Critical Care; D020833:Diffuse Axonal Injury / Q000175:diagnosis; D005240:Feasibility Studies; D005260:Female; D016489:Head Injuries, Closed / Q000175:diagnosis*; D006406:Hematoma / Q000175:diagnosis; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012887:Skull Fractures / Q000175:diagnosis; D020521:Stroke / Q000517:prevention & control; D014193:Trauma Centers