EBQ:Denver Screening Criteria
Background
- Used to screen for injury to the carotid or vertebral vessels after blunt head and neck trauma (BCVI - blunt cerebrovascular injury)[1][2]
- A CTA to evaluate for VAI should be obtained in those meeting the modified Denver Criteria
- BCVI has the highest association with cervical hyperextension and rotation, hyperflexion, or direct blunt force to head and neck[3]
- Most injuries are diagnosed after the development of symptoms secondary to central nervous system ischemia resulting in neurologic morbidity of up to 80% and associated mortality of up to 40%.[4]
Clinical Question
- Can clinical criteria and injury profile and risk factors successfully identify patients at risk for BCVI?
Conclusion
Criteria
- Lateralizing nueurologic deficit (not explained by head CT)
- Infarct on head CT
- Non-expanding cervical hematoma
- Massive epistaxis
- Anisocria or Horner Syndrome
- GCS < 8 without significant head CT findings
- Cervical spine fracture
- Basilar skull fracture
- Le Fort II or III facial fractures
- Seatbelt sign above the clavicle
- Cervical bruit or thrill
Validation
See Also
- Head Trauma (Main)
- Head Trauma (Adult)
- Glasgow Coma Scale (GCS)
- Neck Trauma
- Denver Screening Criteria
Sources
- ↑ Bromberg, William. et al. Blunt Cerebrovascular Injury Practice Management Guidelines: The Eastern Association for the Surgery of Trauma. J Trauma. 68 (2): 471-7, Feb 2010.
- ↑ Cothren CC, Moore EE, Biffl WL, et al. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004;139:540–545; discussion 545–546. PDF
- ↑ Biffl WL, Moore EE, Offner PJ, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178:517–522.
- ↑ Davis JW, Holbrook TL, Hoyt DB, Mackersie RC, Field TO Jr, Shackford SR. Blunt carotid artery dissection: incidence, associated injuries, screening, and treatment. J Trauma. 1990;30:1514–1517