Association between cervical spine and skull-base fractures and blunt cerebrovascular injury

Buch, Karen; Nguyen, Thanh N.; Mahoney, Eric; Libby, Brandon; Calner, Paul; Burke, Peter; Norbash, Alex; Mian, Asim

doi:10.1007/s00330-015-3858-1

Cited by 31 publications

(18 citation statements)

References 32 publications

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“…1,14,15,18,19 These studies were consistent in indicating skull base fractures as a risk factor for BCVI, although fracture types varied. Previously, the focus was on petrous bone fractures and carotid canal involvement, [18][19][20] whereas more recent investigations have taken into account other parts of the skull base [13][14][15] and fronto-orbital area. 11 York et al 21 reported BCVI rates for all types of skull fractures.…”

supporting

confidence: 52%

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Remember the Vessels! Craniofacial Fracture Predicts Risk for Blunt Cerebrovascular Injury

Varjonen

Bensch

Pyhältö

et al. 2018

Journal of Oral and Maxillofacial Surgery

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supporting

confidence: 52%

“…Further studies have suggested expanding screening protocols to include any cervical fracture. 13,14 The role of facial fractures in BCVIs is not completely understood, and BCVIs can be missed when applying insufficient screening protocols. Mundinger et al 15 investigated 4,398 patients with facial fractures and found BCVI in 1.2%.…”

mentioning

confidence: 99%

Remember the Vessels! Craniofacial Fracture Predicts Risk for Blunt Cerebrovascular Injury

Varjonen

Bensch

Pyhältö

et al. 2018

Journal of Oral and Maxillofacial Surgery

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“…As reported by Dewan et al, 21 the main prognostic factor in our cohort appears to be noncerebrovascular injuries present on admission. Also of note is that 11 of 21 patients had subarachnoid hemorrhage on initial presentation, but only 1 of those patients (1 of 21 patients; 4.8%) later developed vasospasm, which is substantially lower than the vasospasm incidence of 10.6% in the adult BCVI population 14 versus approximately 40% in adults with severe head injuries. 48 A noninvasive, nonradiation alternative is to use transcranial Doppler and careful observation to assess the possible future development of vasospasm in patients who present with subarachnoid hemorrhage.…”

Section: Looking To the Future: Determining The Optimal Treatment Formentioning

confidence: 85%

Pediatric blunt cerebrovascular injury: the McGovern screening score

Herbert

Venkataraman

Turkmani

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe objective of this study was to assess the incidence, diagnosis, and treatment of pediatric blunt cerebrovascular injury (BCVI) at a busy Level 1 trauma center and to develop a tool for accurately predicting pediatric BCVI and the need for diagnostic testing.METHODSThis is a retrospective cohort study of a prospectively collected database of pediatric patients who had sustained blunt trauma (patient age range 0–15 years) and were treated at a Level 1 trauma center between 2005 and 2015. Digital subtraction angiography, MR angiography, or CT angiography was used to confirm BCVI. Recently, the Utah score has emerged as a screening tool specifically targeted toward evaluating BCVI risk in the pediatric population. Using logistical regression and adding mechanism of injury as a logit, the McGovern score was able to use the Utah score as a starting point to create a more sensitive screening tool to identify which pediatric trauma patients should receive angiographic imaging due to a high risk for BCVI.RESULTSA total of 12,614 patients (mean age 6.6 years) were admitted with blunt trauma and prospectively registered in the trauma database. Of these, 460 (3.6%) patients underwent angiography after blunt trauma: 295 (64.1%), 107 (23.3%), 6 (1.3%), and 52 (11.3%) patients underwent CT angiography, MR angiography, digital subtraction angiography, and a combination of imaging modalities, respectively. The BCVI incidence (n = 21; 0.17%) was lower than that in a comparable adult group (p < 0.05). The mean patient was age 10.4 years with a mean follow-up of 7.5 months. Eleven patients (52.4%) were involved in a motor vehicle collision, with a mean Glasgow Coma Scale score of 8.6. There were 8 patients (38.1%) with carotid canal fracture, 6 patients (28.6%) with petrous bone fracture, and 2 patients (9.5%) with infarction on initial presentation. Eight patients (38.1%) were managed with observation alone. The Denver, modified Memphis, Eastern Association for the Surgery of Trauma (EAST), and Utah scores, which are the currently used screening tools for BCVI, misclassified 6 (28.6%), 6 (28.6%), 7 (33.3%), and 10 (47.6%) patients with BCVI, respectively, as “low risk” and not in need of subsequent angiographic imaging. By incorporating the mechanism of injury into the score, the McGovern score only misclassified 4 (19.0%) children, all of whom were managed conservatively with no treatment or aspirin.CONCLUSIONSWith a low incidence of pediatric BCVI and a nonsurgical treatment paradigm, a more conservative approach than the Biffl scale should be adopted. The Denver, modified Memphis, EAST, and Utah scores did not accurately predict BCVI in our equally large cohort. The McGovern score is the first BCVI screening tool to incorporate the mechanism of injury into its screening criteria, thereby potentially allowing physicians to minimize unnecessary radiation and determine which high-risk patients are truly in need of angiographic imaging.

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“…Adding to the number of screening criteria, additional Boston Criteria (Tables 1 and 2) have been recently proposed for detection of BCVI, based on a study at Boston Medical Center. 17 The Modified Denver Criteria are most studied, are endorsed by the EAST and Western Trauma Association, and are most commonly used. Because the current literature suggests that BCVI may be missed on the Modified Denver Criteria, further expansion as suggested by the Denver group may be appropriate.…”

Section: Bcvi Screeningmentioning

confidence: 99%

“…9,10 Initially, digital subtraction angiography was used for diagnosis, but with advances in technology, CTA is considered the imaging technique of choice, with a sensitivity and specificity of nearly 98% and 100%, respectively. 11,12 Various screening criteria have been proposed for patients with blunt trauma, with the Modified Denver Criteria being the most accepted [13][14][15] ; however, other criteria (such as the Memphis Criteria 16 and Boston Criteria 17 ) may make implementation of protocol confusing and challenging for practitioners. Also, there are no specific guidelines for screening these injuries in the pediatric population.…”

mentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Advances in Screening, Imaging, and Management Trends

Nagpal

Policeni

Bathla³

et al. 2017

AJNR Am J Neuroradiol

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SUMMARY:Blunt cerebrovascular injury is a relatively uncommon but sometimes life-threatening injury, particularly in patients presenting with ischemic symptoms in that vascular territory. The decision to pursue vascular imaging (generally CT angiography) is based on clinical and imaging findings. Several grading scales or screening criteria have been developed to guide the decision to pursue vascular imaging, as well as to recommend different treatment options for various injuries. The data supporting many of these guidelines and options are limited however. The purpose of this article is to review and compare these scales and criteria and the data supporting clinical efficacy and to make recommendations for future research in this area. ABBREVIATIONS:ATT ϭ antithrombotic therapy; BCVI ϭ blunt cerebrovascular injury; EAST ϭ Eastern Association for the Surgery of Trauma

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Association between cervical spine and skull-base fractures and blunt cerebrovascular injury

Abstract: • CTA screening is important to identify patients with underlying BCVI • Cervical spine and/or skullbase fractures were significantly associated with BCVI • BCVI may occur in up to 11% of patients with blunt trauma injuries.

Cited by 31 publications

References 32 publications

Remember the Vessels! Craniofacial Fracture Predicts Risk for Blunt Cerebrovascular Injury

Remember the Vessels! Craniofacial Fracture Predicts Risk for Blunt Cerebrovascular Injury

Pediatric blunt cerebrovascular injury: the McGovern screening score

Blunt Cerebrovascular Injuries: Advances in Screening, Imaging, and Management Trends

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