Denver screening protocol for blunt cerebrovascular injury reduces the use of multi-detector computed tomography angiography.
BACKGROUND
Blunt cerebrovascular injury (BCVI) occurs in 0.2-2.7% of blunt trauma patients and has up to 30% mortality. Conventional screening does not recognize up to 20% of BCVI patients. To improve diagnosis of BCVI, both an expanded battery of screening criteria and a multi-detector computed tomography angiography (CTA) have been suggested. The aim of this study is to investigate whether the use of CTA restricted to the Denver protocol screen-positive patients would reduce the unnecessary use of CTA as a pre-emptive screening tool.


METHODS
This is a registry-based study of blunt trauma patients admitted to Auckland City Hospital from 1998 to 2012. The diagnosis of BCVI was confirmed or excluded with CTA, magnetic resonance angiography and, if these imaging were non-conclusive, four-vessel digital subtraction angiography.


RESULTS
Thirty (61%) BCVI and 19 (39%) non-BCVI patients met eligibility criteria. The Denver protocol applied to our cohort of patients had a sensitivity of 97% (95% confidence interval (CI): 83-100%) and a specificity of 42% (95% CI: 20-67%). With a prevalence of BCVI in blunt trauma patients of 0.2% and 2.7%, post-test odds of a screen-positive test were 0.03 (95% CI: 0.002-0.005) and 0.046 (95% CI: 0.314-0.068), respectively.


CONCLUSIONS
Application of the CTA to the Denver protocol screen-positive trauma patients can decrease the use of CTA as a pre-emptive screening tool by 95-97% and reduces its hazards.
Department of General Surgery, Auckland City Hospital, Auckland, New Zealand.
Andrei M
AM
Beliaev
P Alan
PA
Barber
Roger J
RJ
Marshall
Ian
I
Civil
D000328:Adult; D000792:Angiography / Q000379:methods*; D001315:Australia; D020214:Cerebrovascular Trauma / Q000175:diagnosis*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*; D055815:Young Adult
blunt cerebrovascular injury; screening; validity