Liberalized screening for blunt carotid and vertebral artery injuries is justified

Background. Current literature suggests that blunt carotid injuries (BCIs) and vertebral artery injuries (BVIs) are more common than once appreciated. Screening criteria have been suggested, but only one previous study has at tempted to identify factors that predict the presence of BCI/BVI. This curr ent study was conducted for two reasons. First, we wanted to determine the incidence of BCI/BVI in our institution. Second, we wanted to determine the incidence of abnormal four-vessel cerebral angiograms ordered for injuries and signs believed to be associated with BCI/BVI and thus to determine whe ther the screening protocol developed was appropriate. Methods. From August 1998, we used liberalized screening criteria for patie nts who were prospectively identified and suspected to be at high risk for BCI/BVI if any of the following were present: anisocoria, unexplained mono- /hemiparesis, unexplained neurologic exam, basilar skull fracture through o r near the carotid canal, fracture through the foramen transversarium, cere brovascular accident or transient ischemic attack, massive epistaxis, sever e flexion or extension cervical spine fracture, massive facial fractures, o r neck hematoma. Four-vessel cerebral angiograms were used for screening fo r BCI/BVI. Results. Over the 18-month study period, 48 patients were angiographically screened, with 21 patients (44%) being identified as having a total of 19 B CIs and 10 BVIs. Nine patients had unilateral carotid artery injuries and t hree patients had bilateral carotid artery injuries. Vertebral artery injur ies were unilateral in six patients. One patient had bilateral carotid arte ry injuries and a unilateral vertebral artery injury. One patient had a uni lateral carotid artery injury and a unilateral vertebral artery injury, and one patient had a unilateral carotid artery in-jury and bilateral vertebra l artery injuries. During the same study period, 2,331 trauma patients were admitted, with 1,941 (83%) secondary to blunt trauma. The overall incidenc e of BCI/BVI was 1.1%. The frequency of abnormal angiograms ordered for cer ebrovascular accident or transient ischemic attack, massive epistaxis, or s evere cervical spine fractures was 100%. The frequency of abnormal angiogra ms ordered for the other indications was as follows: fracture through foram en transversarium, 60%; unexplained mono- or hemiparesis, 44%; basilar skul l fracture, 42%; unexplained neurologic examination, 38%; anisocoria, 33%; and severe facial fractures, 0%. Conclusion. The liberalized screening criteria used in this study were appr opriate to identify patients with BCI/BVI. This study suggests BCI/BVl to b e more common than previously believed and justifies that screening should be liberalized.