EBQ:Denver Screening Criteria

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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

  1. Lateralizing nueurologic deficit (not explained by head CT)
  2. Infarct on head CT
  3. Non-expanding cervical hematoma
  4. Massive epistaxis
  5. Anisocria or Horner Syndrome
  6. GCS < 8 without significant head CT findings
  7. Cervical spine fracture
  8. Basilar skull fracture
  9. Le Fort II or III facial fractures
  10. Seatbelt sign above the clavicle
  11. Cervical bruit or thrill

Validation

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