title: Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated.
abstract: BACKGROUND
  We implemented expanded screening criteria for blunt cerebrovascular injuries (BCVIs) in an attempt to capture the remaining 20% of patients not historically identified with earlier protocols. We hypothesized that these expanded criteria would capture the additional 20% of BCVI patients not previously identified.
  
  
  METHODS
  Screening criteria for BCVI were expanded in 2011 after identifying new injury patterns. The study population included 4 years prior (2007 to 2010; classic) and following (2011 to 2014; expanded) implementation of expanded criteria.
  
  
  RESULTS
  BCVIs were identified in 386 patients: 150 during the classic period (2.36% incidence) and 236 in the expanded period (2.99% incidence). In the expanded period, 155 patients were imaged based on classic screening criteria, 62 on expanded criteria (21 complex skull fractures, 20 upper rib fractures, 6 mandible fractures, 2 scalp degloving, 1 great vessel injury, and 12 combination), and 19 for other injuries and symptoms.
  
  
  CONCLUSIONS
  There was a significant increase in the identification of BCVI following the adoption of expanded screening criteria, resulting in a substantial reduction of missed injuries. Expanded criteria should be adopted when screening for BCVI.
authors.affiliation: Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Geddes
authors.affiliation: Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA. Electronic address: clay.cothren@dhha.org.
authors.forename: Clay Cothren
authors.initials: CC
authors.lastname: Burlew
authors.affiliation: Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wagenaar
authors.affiliation: Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: Walter L
authors.initials: WL
authors.lastname: Biffl
authors.affiliation: Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Johnson
authors.affiliation: Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: Fredric M
authors.initials: FM
authors.lastname: Pieracci
authors.affiliation: Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Campion
authors.affiliation: Department of Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA.
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020214:Cerebrovascular Trauma / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012307:Risk Factors; D055815:Young Adult
keywords: Blunt cerebrovascular injuries; Carotid artery injury; Screening criteria; Stroke; Traumatic vascular injury; Vertebral artery injury