Casado-Ruiz Julia, Castaño-Leon Ana M, García-Escudero Laura, Huerta-Carrascosa Maria, Vidal-Terrancle Marta, Lagares Alfonso
1Neurosurgery Department, Hospital Regional Universitario de Malaga.
2Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid.
J Neurosurg. 2025 Apr 4;143(2):461-471. doi: 10.3171/2024.12.JNS241294. Print 2025 Aug 1.
Blunt cerebrovascular injuries (BCVIs) are associated with significant morbidity and mortality. To identify patients with BCVI who were undetected using the classic criteria, researchers designed the expanded Denver screening criteria. The aim of this study was to evaluate adherence to the classic and expanded screening protocols. The authors then assessed the impact of this transition on the identification of BCVI and the development of ischemic brain injuries.
Patients with moderate to severe traumatic brain injury (TBI) admitted to the authors' center between 2014 and 2021 were retrospectively reviewed. Patient characteristics, adherence to the screening protocol, the incidence of BCVI detected by CT angiography (CTA) or digital subtraction angiography, and the development of ischemia in patients admitted before (2014-2018) and after (2019-2021) the implementation of the expanded Denver criteria were compared. Comparisons in qualitative and quantitative variables between periods were performed using the chi-square test and Mann-Whitney U-test, respectively. Which individual criterion was most associated with adherence to the protocol and incidence of BCVI according to multivariate logistic regression analysis was also determined. The performance of each screening protocol was determined using the C-statistic.
Of the 648 patients with TBI identified during the study period, 397 were recruited in the classic period (2014-2018) and 251 in the expanded period (2019-2021). The rate of adherence to the screening protocol was 58.9% in the classic period and 78.1% in the expanded period (p < 0.001). BCVIs were detected in 38 patients (9.6% incidence) in the classic period and 20 patients (8% incidence) in the expanded period. If the classic criteria had been used in the 2019-2021 period, 14 CT angiograms would not have been performed. During the classic period, 27 patients (6.8%) developed ischemia. In 5 (18.5%) of these 27 patients, ischemia could not be prevented because they were not screened through CTA despite fulfilling the criteria. In the expanded period, 24 patients (9.6%) developed ischemia, with no CTA performed in just 1 patient (4.2%), despite meeting the criteria for screening (p = 0.125).
Despite the improvement in adherence and the enhanced diagnosis of BCVI following training and the implementation of the expanded Denver criteria, the study failed to find a significant reduction in delayed ischemia, while acknowledging the potential for other contributing factors. Further endeavors should be conducted to ensure protocol adherence and early diagnosis of patients at risk of BCVI.
钝性脑血管损伤（BCVI）与显著的发病率和死亡率相关。为了识别那些未被经典标准检测出的BCVI患者，研究人员设计了扩展的丹佛筛查标准。本研究的目的是评估对经典和扩展筛查方案的依从性。作者随后评估了这一转变对BCVI识别及缺血性脑损伤发生情况的影响。
对2014年至2021年期间入住作者所在中心的中重度创伤性脑损伤（TBI）患者进行回顾性研究。比较患者特征、对筛查方案的依从性、通过CT血管造影（CTA）或数字减影血管造影检测出的BCVI发生率，以及在扩展的丹佛标准实施之前（2014 - 2018年）和之后（2019 - 2021年）入院患者的缺血发生情况。分别使用卡方检验和曼 - 惠特尼U检验对不同时期的定性和定量变量进行比较。通过多因素逻辑回归分析确定与方案依从性和BCVI发生率最相关的个体标准。使用C统计量确定每个筛查方案的性能。
在研究期间确定的648例TBI患者中，397例在经典时期（2014 - 2018年）入组，251例在扩展时期（2019 - 2021年）入组。经典时期对筛查方案的依从率为58.9%，扩展时期为78.1%（p < 0.001）。经典时期38例患者（发生率9.6%）检测出BCVI，扩展时期20例患者（发生率8%）检测出BCVI。如果在2019 - 2021年期间使用经典标准，将不会进行14次CT血管造影检查。在经典时期，27例患者（6.8%）发生缺血。在这27例患者中的5例（18.5%）中，尽管符合标准，但由于未通过CTA进行筛查，缺血无法预防。在扩展时期，24例患者（9.6%）发生缺血，尽管符合筛查标准，但仅有1例患者（4.2%）未进行CTA检查（p = 0.125）。
尽管经过培训并实施扩展的丹佛标准后，依从性有所提高且BCVI诊断得到加强，但该研究未能发现延迟缺血有显著减少，同时承认可能存在其他促成因素。应进一步努力确保方案依从性并对有BCVI风险的患者进行早期诊断。
