Diagnostic yield and clinical predictors of blunt cerebrovascular injury: A CTA utilization review at a level I trauma center.

IF 1.2 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Emergency Radiology Pub Date : 2026-08-15 DOI:10.1007/s10140-026-02530-x

Pharis B Sasa, Tasneem Zaihra Rizvi, Sandra Mackey, Nathan Cuttita, Eric Mahoney

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引用次数: 0

Abstract

Purpose: Blunt cerebrovascular injury (BCVI) is a potentially devastating complication of high-energy trauma that can lead to ischemic stroke if undetected. Computed tomography angiography (CTA) is the primary screening modality, though optimal patient selection criteria remain debated. Rising CTA utilization at our institution prompted a quality improvement review to evaluate the diagnostic yield and identify clinical predictors of BCVI.

Methods: A retrospective review was conducted of trauma patients who underwent CTA of the head and neck at a Level I trauma center between January and December 2023.Clinical variables were compared between patients with and without BCVI on univariate analysis, and independent predictors were identified using multivariate logistic regression.

Results: Among 305 patients screened, BCVI was identified in 40 patients (13.1%), with a total of 44 injuries due to multivessel involvement in 4 patients. Vertebral artery injuries predominated (34/44,77.3%), with Grade 1 being most common (18/44,40.9%). Loss of consciousness (OR 2.96; 95% CI 1.43-6.29; p = 0.003) and cervical spine fracture (OR 8.06; 95% CI 3.86-17.9; p < 0.001) were independent predictors of BCVI on multivariate analysis. The multivariate model demonstrated good discriminatory performance (AUROC = 0.788; 95% CI 0.707-0.868).

Conclusions: In a screened trauma cohort, LOC at the scene was a strong independent predictor of BCVI, a relationship not previously incorporated into formal screening criteria. These findings support prospective evaluation of LOC as a clinically accessible adjunct to existing risk-stratification tools.

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钝性脑血管损伤的诊断率和临床预测因素：一个一级创伤中心的CTA使用回顾。

目的：钝性脑血管损伤（BCVI）是一种潜在的破坏性高能量创伤并发症，如果未被发现，可导致缺血性卒中。计算机断层血管造影（CTA）是主要的筛查方式，但最佳的患者选择标准仍存在争议。我院CTA使用率的提高促使开展了质量改进审查，以评估BCVI的诊断率并确定BCVI的临床预测因素。方法：回顾性分析2023年1月至12月在一级创伤中心接受头颈部CTA的创伤患者。采用单因素分析比较BCVI患者和非BCVI患者的临床变量，采用多因素logistic回归确定独立预测因素。结果：在305例筛查患者中，40例患者（13.1%）发现BCVI，其中4例患者共44例因多血管受累而损伤。椎动脉损伤居多（34/44,77.3%），其中1级损伤最为常见（18/44,40.9%）。意识丧失（OR 2.96; 95% CI 1.43-6.29; p = 0.003）和颈椎骨折（OR 8.06; 95% CI 3.86-17.9; p）结论：在筛选过的创伤队列中，现场LOC是BCVI的一个强有力的独立预测因子，这一关系以前未被纳入正式的筛查标准。这些发现支持对LOC进行前瞻性评估，将其作为现有风险分层工具的临床辅助手段。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Emergency Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

4.60

自引率

4.50%

发文量

期刊介绍： To advance and improve the radiologic aspects of emergency careTo establish Emergency Radiology as an area of special interest in the field of diagnostic imagingTo improve methods of education in Emergency RadiologyTo provide, through formal meetings, a mechanism for presentation of scientific papers on various aspects of Emergency Radiology and continuing educationTo promote research in Emergency Radiology by clinical and basic science investigators, including residents and other traineesTo act as the resource body on Emergency Radiology for those interested in emergency patient care Members of the American Society of Emergency Radiology (ASER) receive the Emergency Radiology journal as a benefit of membership!