From the Wake Forest School of Medicine (K.S.H., R.A., C.S.O., N.P.P., C.P.G., S.Q.W., M.E.Z.). Winston-Salem, North Carolina
Department of Radiology (K.D.H., C.P.G., S.Q.W., M.E.Z.), Atrium Health Wake Forest Baptist.
AJNR Am J Neuroradiol. 2023 Nov;44(11):1296-1301. doi: 10.3174/ajnr.A8004. Epub 2023 Oct 12.
Screening patients with trauma for blunt cerebrovascular injury with neck CTA is a common practice, but there remains disagreement regarding which patients should be screened. We reviewed adult blunt cerebrovascular injury data from a level 1 trauma center to investigate whether screening is warranted in low-mechanism trauma.
We reviewed all neck CTAs performed on adult trauma patients in the emergency department during the 2019 calendar year. Clinical and imaging risk factors for blunt cerebrovascular injury, trauma mechanism, initial neck CTA interpretations, results from subsequent CTA and DSA studies, antiplatelet and anticoagulant treatments, and outcome data were recorded.
One thousand one hundred thirty-six neck CTAs met the inclusion criteria, of which 965 (85%) were interpreted as having negative findings; 125, as having indeterminate findings (11%); and 46, as having positive findings (4%). Review of subsequent imaging and clinical documentation led to classification of 40 indeterminate studies (32%) as true-positives and 85 (68%) as false-positives. Blunt cerebrovascular injury was identified in 77 (12.6%) cases meeting and in 9 (1.7%) cases not meeting the expanded Denver criteria. The subset of 204 low-mechanism trauma cases (ground-level falls, blunt assaults, and low-impact motor vehicle collisions) not meeting the expanded Denver criteria (18% of the entire data set) could have been excluded from screening with 1 questionable injury and 0 ischemic strokes missed and 12 false-positive cases prevented.
We advocate reservation of blunt cerebrovascular injury screening in low-mechanism trauma for patients meeting the expanded Denver criteria. Further research is needed to determine the behavior of indeterminate cases and to establish criteria for separating true-positive from false-positive findings.
对创伤患者进行颈部 CTA 筛查以发现钝性脑血管损伤是一种常见做法，但对于应筛选哪些患者仍存在分歧。我们回顾了一家一级创伤中心的成人钝性脑血管损伤数据，以研究在低机制创伤中是否需要进行筛查。
我们回顾了 2019 年全年在急诊科接受颈部 CTA 的所有成年创伤患者的数据。记录了钝性脑血管损伤的临床和影像学危险因素、创伤机制、初始颈部 CTA 解读、随后的 CTA 和 DSA 研究结果、抗血小板和抗凝治疗以及预后数据。
1136 份颈部 CTA 符合纳入标准，其中 965 份（85%）解读为阴性结果；125 份为不确定结果（11%）；46 份为阳性结果（4%）。对随后的影像学和临床记录进行审查后，将 40 份不确定研究（32%）归类为真阳性，85 份（68%）归类为假阳性。符合扩大的丹佛标准的 77 例（12.6%）和不符合扩大的丹佛标准的 9 例（1.7%）患者中均发现了钝性脑血管损伤。不符合扩大的丹佛标准的 204 例低机制创伤病例（地面水平坠落、钝器打击和低影响机动车碰撞）（整个数据集的 18%）可能已经排除了筛查，漏诊了 1 例可疑损伤和 0 例缺血性中风，避免了 12 例假阳性病例。
我们主张对符合扩大的丹佛标准的低机制创伤患者保留钝性脑血管损伤筛查。需要进一步研究来确定不确定病例的行为，并建立区分真阳性和假阳性的标准。
