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Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated

2016; Elsevier BV; Volume: 212; Issue: 6 Linguagem: Inglês

10.1016/j.amjsurg.2016.09.016

1879-1883

Andrea E. Geddes, Clay Cothren Burlew, Amy E. Wagenaar, Walter L. Biffl, Jeffrey L. Johnson, Fredric M. Pieracci, Eric M. Campion, Ernest E. Moore,

Pelvic and Acetabular Injuries

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.