🧠 Blunt Cerebrovascular Injury Screening (Expanded Denver)
This tool applies the expanded Denver criteria to decide whether blunt trauma warrants neck CT angiography to screen for blunt cerebrovascular injury (BCVI).
Blunt Cerebrovascular Injury Screening (Expanded Denver)
BCVI signs/symptoms (any): arterial bleeding from neck/nose/mouth, cervical bruit (<50 yr), expanding cervical hematoma, focal neurologic deficit (TIA/hemiparesis/Horner/vertebrobasilar), deficit incongruent with head CT, ischemic stroke on CT/MRI
Risk factors (high-energy mechanism + any): Le Fort II/III, mandible fracture, skull-base/complex skull fracture, cervical spine fracture (esp. C1–3/transverse-foramen/subluxation), DAI or GCS <6, near-hanging with hypoxia, seatbelt/clothesline-type neck injury, scalp degloving, great-vessel chest injury
When to use
Use during trauma evaluation to identify patients who should undergo neck CTA based on BCVI signs/symptoms or high-risk injury mechanisms, since most BCVI is initially asymptomatic.
How it works
Screen positive if any BCVI sign/symptom OR any high-risk factor is present → neck CTA recommended. Signs/symptoms drive a high-priority (emergent imaging) pathway; risk factors alone drive a screening pathway.
Key points
- BCVI stroke risk is roughly 1–10% and highest within 72 h, so proactive screening of high-risk mechanisms matters even when the patient is asymptomatic. (original synthesis · not guideline verbatim)
- Confirmed BCVI is usually treated with antithrombotic therapy, balanced against bleeding risk from concomitant TBI, solid-organ, or pelvic injury.
- The expanded Denver criteria can still miss cases; some centers screen more liberally.
References
- Biffl WL, et al. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma 1999.
- Burlew CC, et al. Blunt cerebrovascular injuries: redefining screening criteria. J Trauma Acute Care Surg 2012.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.