From the University of Maryland Medical Center (B.R.B., R.T., C.S., A.L., T.M.S., D.M.S.), Shock Trauma and Anesthesiology Research-Organized Research Center (J.K.), R Adams Cowley Shock Trauma Center, Baltimore, Maryland.
J Trauma Acute Care Surg. 2014 Mar;76(3):691-5. doi: 10.1097/TA.0b013e3182ab1b4d.
Blunt cerebrovascular injury (BCVI) is reported to occur in approximately 2% of blunt trauma patients, with a stroke rate of up to 20%. Guidelines for BCVI screening are based on clinical and radiographic findings. We hypothesized that liberal screening of the neck vasculature, as part of initial computed tomographic (CT) imaging in blunt trauma patients with significant mechanisms of injury, identifies BCVI that may go undetected.
As per protocol, patients at risk for significant injuries undergo a noncontrast head CT scan followed by a multislice CT scan (40-slice or 64-slice) incorporating an intravenous contrast-enhanced pass from the circle of Willis through the pelvis (whole-body CT [WBCT] scan). The trauma registry was retrospectively reviewed, and all patients with BCVI from 2009 to 2012 were analyzed. Patients undergoing WBCT scan were then identified, and records were reviewed for BCVI indicators (skull base fracture, cervical spine injury, displaced facial fracture, mandible fracture, Glasgow Coma Scale score ≤ 8, flexion mechanism, hard signs of neck vascular injury, or focal neurologic deficit).
Of 16,026 patients evaluated during the study period, 256 (1.6%) were diagnosed with BCVI. The population consisted of 185 patients with suspected BCVI after WBCT scan. One hundred twenty-nine patients (70%) had at least one indicator for BCVI screening, while 56 (30%) had no radiographic or clinical risk factors; 48 of the 56 patients underwent confirmatory CT angiography of the neck within 71 hours of initial WBCT scan, with 35 patients having 45 injuries.
More liberalized screening for BCVI during initial CT imaging in trauma patients clinically judged to have sufficient mechanism is warranted. Using current BCVI screening guidelines leads to missed BCVI and risk of stroke.
Diagnostic study, level III.
据报道，钝性脑血管损伤（BCVI）在大约 2%的钝性创伤患者中发生，其卒中发生率高达 20%。BCVI 筛查指南基于临床和影像学发现。我们假设，在机制严重的钝性创伤患者中，作为初始计算机断层扫描（CT）成像的一部分，广泛筛查颈部血管，可发现可能未被发现的 BCVI。
根据方案，有发生重大损伤风险的患者行非增强头部 CT 扫描，然后行多层 CT 扫描（40 层或 64 层），包括从 Willis 环到骨盆的静脉对比增强通过（全身 CT [WBCT] 扫描）。回顾性审查创伤登记处，并分析了 2009 年至 2012 年所有的 BCVI 患者。然后确定行 WBCT 扫描的患者，并回顾记录 BCVI 指标（颅底骨折、颈椎损伤、移位面骨骨折、下颌骨骨折、格拉斯哥昏迷评分≤8、屈曲机制、颈血管损伤的硬体征或局灶性神经功能缺损）。
在研究期间评估的 16026 例患者中，有 256 例（1.6%）被诊断为 BCVI。该人群包括 WBCT 扫描后疑似 BCVI 的 185 例患者。129 例患者（70%）至少有一项 BCVI 筛查指标，而 56 例患者（30%）无影像学或临床危险因素；56 例患者中有 48 例在初始 WBCT 扫描后 71 小时内行颈部 CT 血管造影检查，其中 35 例患者有 45 处损伤。
在临床上判断机制充分的创伤患者的初始 CT 成像中，更广泛地筛查 BCVI 是合理的。使用当前的 BCVI 筛查指南会导致 BCVI 漏诊和卒中风险。
诊断研究，III 级。
