Optimizing screening for blunt cerebrovascular injuries

BACKGROUND: The recognition that early diagnosis and intervention, prior to ischemic neurologic injury, has the potential to improve outcome following blunt cerebrovascular injuries (BCVI), led to a policy of aggressive scree ning for these injuries, The resultant epidemic of BCVI has created a dilem ma, as widespread screening is impractical, We sought to identify independe nt predictors of BCVI, to focus resources, METHODS: Cerebral arteriography was performed based on signs or symptoms of BCVI, or in asymptomatic patients with high-risk mechanisms (hyperextensio n, hyperflexion, direct blow) or injury patterns. Logistic regression analy sis identified independent predictors. RESULTS: A total of 249 patients underwent arteriography; 85 (34%) had inju ries. Independent predictors of carotid arterial injury were Glasgow coma s core less than or equal to 6, petrous bone fracture, diffuse axonal brain i njury, and LeFort II or III fracture, Having one of these factors in the se tting of a high-risk mechanism was associated with 41% risk of injury, Of p atients with cervical spine fracture, 39% had vertebral arterial injury, CONCLUSIONS: Patients sustaining high-risk injury mechanisms or patterns sh ould be screened for BCVI, In the face of limited resources, screening effo rts should be focused on those with high-risk predictors, Am J Surg. 1999;1 78:517-522. (C) 1999 by Excerpta Medica, Inc.