Screening for blunt cerebrovascular injuries is cost-effective

Cothren, Clay C.; Moore, Ernest E.; Ray, Charles E.; Ciesla, David J.; Johnson, Jeffrey L.; Moore, John B.; Burch, Jon M.

doi:10.1016/j.amjsurg.2005.08.007

Cited by 158 publications

(124 citation statements)

References 18 publications

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“…Our group's most recent evaluation demonstrated a stroke rate of 0.5% in 187 patients with BCVI treated with antithrombotics, while untreated patients had an overall stroke rate of 21%. 10 Although the optimal regimen remains undetermined, there appears to be equivalence between the two therapies. [2][3][4] To determine the ideal therapeutic regimen for BCVI, we are currently enrolling patients in a prospective randomized study comparing antiplatelet agents to intravenous heparin in patients with grades I to III injuries.…”

Section: Treatment: Antithromboticsmentioning

confidence: 99%

“…Our most recent evaluation of endovascular stents in patients with postinjury BCVI, however, suggests that antithrombotic therapy remains the gold standard treatment. 10 Patients with carotid or vertebral artery occlusions may not require reimaging, as 82% showed no change on follow-up imaging. 3…”

Section: Diagnostic Imaging and Injury Grading Scalementioning

confidence: 99%

“…Current studies suggest that early antithrombotic therapy in patients with BCVI reduces stroke rates and prevents neurologic morbidity. 1,3,4,[8][9][10][11] …”

mentioning

confidence: 99%

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Blunt Cerebrovascular Injuries

Cothren¹,

Moore²

2008

Current Therapy of Trauma and Surgical Critical Care

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Section: Treatment: Antithromboticsmentioning

confidence: 99%

Section: Diagnostic Imaging and Injury Grading Scalementioning

confidence: 99%

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Blunt Cerebrovascular Injuries

Cothren¹,

Moore²

2008

Current Therapy of Trauma and Surgical Critical Care

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“…These factors and tracer diagnoses have been introduced by the Denver [6] and Memphis trauma groups [16] and have been used in many studies [8,13,14].…”

Section: Discussionmentioning

confidence: 99%

“…Although screening protocols have been introduced in the literature [13,19,25,27], the diagnostic cascade of many hospitals does not focus on BCVIs because the recommended algorithms are not applicable for acute trauma care. To address this limitation, we developed a standardised screening protocol which is also feasible for severely injured patients (ISS [ 16 pts.…”

Section: Introductionmentioning

confidence: 99%

Blunt cerebrovascular injuries in acute trauma care: a screening protocol

et al. 2011

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Introduction 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. Materials and 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. Conclusion Our results indicate that implementation of the screening protocol can prevent strokes in patients without primary thrombembolic neurological deficits.

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