The Use of High-Risk Criteria in Screening Patients for Blunt Cerebrovascular Injury: A Survey

Acad Radiol. 2017 Apr;24(4):456-461. doi: 10.1016/j.acra.2016.11.010. Epub 2016 Dec 12.


Rationale and objectives: Blunt cerebrovascular injury (BCVI) is uncommon, but delayed detection can have disastrous consequences. The Denver criteria are the most commonly used screening criteria. We aim to examine the utilization of screening criteria in the emergency department (ED) of our institution and assess whether patients with risk factors were imaged.

Materials and methods: A survey questionnaire was sent out to radiologists in a large academic institution. A search was performed in the database on the use of CT angiography (CTA) and MR angiography (MRA) among patients with risk factors in the last 11 years.

Results: The survey was sent to 173 radiologists, with 41 responses (35 complete). Most of the physicians (30 out of 35) surveyed selected CTA as their preferred modality to screen for BCVI, whereas the remaining physicians selected MRA. None of the respondents reported routine use of Denver screening criteria or grading scale in their readouts. Only five respondents selected risk factors in the Denver criteria correctly. In the institution search, among the 1331 patients with blunt trauma and risk factors for BCVI, 537 underwent at least one angiographic study (40.3%). There was an increase in the screening rate after February 2010 in all risk factors, but only statistically significant among patients with foramen transversarium fractures and C1-C3 fractures.

Conclusions: Both the Denver screening criteria and grading scale of vascular injury have been underutilized in the ED for patients with risk factors. Greater awareness and utilization of imaging can potentially result in decreased incidence of subsequent stroke in patients with blunt injury.

Keywords: Denver criteria; angiography; blunt cerebrovascular injury; trauma; utilization analysis.

MeSH terms

  • Attitude of Health Personnel
  • Cerebral Angiography* / methods
  • Cerebral Angiography* / statistics & numerical data
  • Cerebrovascular Trauma* / diagnosis
  • Cerebrovascular Trauma* / diagnostic imaging
  • Computed Tomography Angiography* / methods
  • Computed Tomography Angiography* / statistics & numerical data
  • Databases, Factual
  • Delayed Diagnosis / prevention & control
  • Emergency Service, Hospital
  • Humans
  • Magnetic Resonance Angiography* / methods
  • Magnetic Resonance Angiography* / statistics & numerical data
  • Mass Screening* / methods
  • Mass Screening* / standards
  • Radiologists / statistics & numerical data
  • Risk Assessment* / methods
  • Risk Assessment* / standards
  • Risk Factors
  • Surveys and Questionnaires
  • United States
  • Wounds, Nonpenetrating* / diagnosis
  • Wounds, Nonpenetrating* / diagnostic imaging