Division of Trauma/Critical Care, University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.
Department of Surgery, University of California, San Francisco, CA, USA.
Am Surg. 2021 Mar;87(3):390-395. doi: 10.1177/0003134820951475. Epub 2020 Sep 29.
Current screening criteria miss 30% of blunt cerebrovascular injuries (BCVIs). Motor vehicle collisions (MVCs) are the leading BCVI mechanism, and delineating MVC characteristics associated with BCVI formation may augment current screening criteria.
We retrospectively identified BCVI Denver injury screening criteria as able from the Crash Injury Research and Engineering Network (CIREN) database. Severe MVC markers were considered: mean change in velocity (delta-v) greater than 40 km/hour, steering wheel airbag deployment, ejection, or rollover.
93 BCVIs were included. Injury screening criteria were not present in 37/93 (39.8%) BCVIs. Vertebral BCVI more often had injury screening criteria than internal carotid BCVIs (73.2% vs 26.8%, = .001). There was a significant difference in delta-v (30.78 km/hour vs 51.00 km/hour, < .001) between BCVI with and without injury screening criteria. BCVI without injury screening criteria more often had safety device use through seatbelt position snug across the hips (94.6% vs 74.5%, = .01) and pretensioner deployment (92.6% vs 70.2%, = .04). Examining only drivers, BCVI without injury screening criteria more often had steering wheel airbag deployment (89.7% vs 68.9%, = .05). Markers of severe MVC were seen in 36/37 (97.3%) BCVIs without injury screening criteria.
BCVI without injury screening criteria occurred during higher deceleration MVCs with more frequent/appropriate safety device use, suggesting crash deceleration as a mechanism of BCVI formation. Expanding BCVI screening criteria to encompass severe MVCs may lessen the number of BCVI missed.
目前的筛选标准会漏掉 30%的钝性脑血管损伤（BCVI）。机动车碰撞（MVC）是导致 BCVI 的主要机制，明确与 BCVI 形成相关的 MVC 特征可能会增加当前的筛选标准。
我们从 Crash Injury Research and Engineering Network（CIREN）数据库中回顾性地确定了 BCVI 丹佛筛选标准。严重 MVC 标志物包括：速度变化（delta-v）大于 40 公里/小时、方向盘安全气囊展开、弹射或翻车。
93 例 BCVI 患者入选。37/93（39.8%）例 BCVI 患者无损伤筛选标准。与颈内动脉 BCVI 相比，椎动脉 BCVI 更常见符合损伤筛选标准（73.2% vs 26.8%， =.001）。有损伤筛选标准和无损伤筛选标准的 BCVI 之间 delta-v 差异有统计学意义（30.78 公里/小时 vs 51.00 公里/小时， <.001）。无损伤筛选标准的 BCVI 更常见安全带位置舒适地横跨臀部（94.6% vs 74.5%， =.01）和预紧器展开（92.6% vs 70.2%， =.04）。仅检查驾驶员，无损伤筛选标准的 BCVI 更常见方向盘安全气囊展开（89.7% vs 68.9%， =.05）。无损伤筛选标准的 37 例 BCVI 中有 36 例（97.3%）存在严重 MVC 标志物。
无损伤筛选标准的 BCVI 发生在减速幅度更大的 MVC 中，安全装置使用更频繁/更合适，这表明碰撞减速是 BCVI 形成的机制。扩大 BCVI 筛选标准以涵盖严重 MVC 可能会减少漏诊的 BCVI 数量。
