Difference between revisions of "EBQ:Denver Screening Criteria"

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==Conclusion==
 
==Conclusion==
 +
Denver criteria can successfully identify trauma patients at risk for vascular injury.
 +
*5% of trauma patients were screened
 +
*18% of screened patients had a vascular injury
 +
==Criteria==
 +
''screening criteria are divided into risk factors and signs and symptoms''
 +
===Signs and Symptoms===
 +
*[[CVA_(Workup_and_General_Rx)|Focal neurologic deficit]]
 +
*Arterial Hemorrhage
 +
*Cervical Bruit or Thrill (<50yo)
 +
*Infarct on Head CT
 +
*Expanding Neck Hematoma
 +
*Neuro exam inconsistent with Head CT
 +
 +
===Risk Factors===
 +
*[[Le Fort fractures]]
 +
*[[Cervical Spine Injuries]]
 +
*Basilar Skull Fracture
 +
*GCS<8
 +
*Hanging with Anoxic Brain Injury
  
==Criteria==
 
#Lateralizing neurologic 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 Injuries|Cervical spine fracture]]
 
#Basilar skull fracture
 
#[[Le Fort Fractures|Le Fort]] II or III facial fractures
 
#Seatbelt sign above the clavicle
 
#Cervical bruit or thrill
 
  
 
==Validation==
 
==Validation==
 
+
*The Denver Criteria has not been externally validated
 
==See Also==
 
==See Also==
 
{{Head Neck Trauma}}
 
{{Head Neck Trauma}}
  
 
==Sources==
 
==Sources==
 +
<references/>
  
 
[[Category:Trauma]][[Category:EBQ]]
 
[[Category:Trauma]][[Category:EBQ]]
<references/>
 

Revision as of 03:55, 12 November 2014

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]
Algorithm for evaluation of BCVI with high risk criteria based on Memphis and Denver Screening Criteria

Clinical Question

  • Can clinical criteria and injury profile and risk factors successfully identify patients at risk for BCVI?

Conclusion

Denver criteria can successfully identify trauma patients at risk for vascular injury.

  • 5% of trauma patients were screened
  • 18% of screened patients had a vascular injury

Criteria

screening criteria are divided into risk factors and signs and symptoms

Signs and Symptoms

  • Focal neurologic deficit
  • Arterial Hemorrhage
  • Cervical Bruit or Thrill (<50yo)
  • Infarct on Head CT
  • Expanding Neck Hematoma
  • Neuro exam inconsistent with Head CT

Risk Factors


Validation

  • The Denver Criteria has not been externally validated

See Also

Sources

  1. 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.
  2. 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
  3. Biffl WL, Moore EE, Offner PJ, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178:517–522.
  4. 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