Denver screening protocol for blunt cerebrovascular injury reduces the use of multi‐detector computed tomography angiography

Blunt cerebrovascular injury (BCVI) occurs in 0.2–2.7% of blunt trauma patients and has up to 30% mortality. Conventional screening does not recognize up to 20% of BCVI patients. To improve diagnosis of BCVI, both an expanded battery of screening criteria and a multi‐detector computed tomography angiography (CTA) have been suggested. The aim of this study is to investigate whether the use of CTA restricted to the Denver protocol screen‐positive patients would reduce the unnecessary use of CTA as a pre‐emptive screening tool.

[1]  S. Prakkamakul.  Incidence and severity of acute adverse reactions to intravenous iodinated contrast media: 8-year experience in King Chulalongkorn Memorial Hospital , 2013 .

[2]  J. Mathews,et al.  Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians , 2013, BMJ.

[3]  J. Hamming,et al.  Contrast-induced acute kidney injury and clinical outcomes after intra-arterial and intravenous contrast administration: risk comparison adjusted for patient characteristics by design. , 2013, American heart journal.

[4]  G. Hobbs,et al.  Repeated computed tomographic scans in transferred trauma patients: Indications, costs, and radiation exposure , 2012, The journal of trauma and acute care surgery.

[5]  A. Annoni,et al.  Cumulative radiation exposure during thoracic endovascular aneurysm repair and subsequent follow-up. , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[6]  Khoi D. Than,et al.  Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury , 2012, The journal of trauma and acute care surgery.

[7]  M. Wright,et al.  A systematic review and meta-analysis of diagnostic screening criteria for blunt cerebrovascular injuries. , 2012, Journal of the American College of Surgeons.

[8]  E. Moore,et al.  Blunt cerebrovascular injuries: Redefining screening criteria in the era of noninvasive diagnosis , 2012, Journal of Trauma and Acute Care Surgery.

[9]  T. Osler,et al.  Blunt cerebrovascular injury is poorly predicted by modeling with other injuries: analysis of NTDB data. , 2011, The Journal of trauma.

[10]  Ben L Zarzaur,et al.  Improving the screening criteria for blunt cerebrovascular injury: the appropriate role for computed tomography angiography. , 2011, The Journal of trauma.

[11]  M. Harrigan,et al.  Cerebrovascular Dissections: A Review. Part II: Blunt Cerebrovascular Injury , 2011, Neurosurgery.

[12]  T. Scalea,et al.  Blunt cerebrovascular injuries: does treatment always matter? , 2009, The Journal of trauma.

[13]  Jagdish Singh,et al.  Iodinated Contrast Media and Their Adverse Reactions* , 2008, Journal of Nuclear Medicine Technology.

[14]  H. Terada,et al.  Evaluation of the acute adverse reaction of contrast medium with high and moderate iodine concentration in patients undergoing computed tomography , 2006, Radiation Medicine.

[15]  S. Silverman,et al.  Universal use of nonionic iodinated contrast medium for CT: evaluation of safety in a large urban teaching hospital. , 2005, AJR. American journal of roentgenology.

[16]  T. Fabian,et al.  Prospective Screening for Blunt Cerebrovascular Injuries: Analysis of Diagnostic Modalities and Outcomes , 2002, Annals of surgery.

[17]  E. Moore,et al.  Treatment-Related Outcomes From Blunt Cerebrovascular Injuries: Importance of Routine Follow-Up Arteriography , 2002, Annals of surgery.

[18]  T. Fabian,et al.  Blunt cerebrovascular injuries: diagnosis and treatment. , 2001, The Journal of trauma.

[19]  J. Sayre,et al.  Trends in adverse events after IV administration of contrast media. , 2001, AJR. American journal of roentgenology.

[20]  E. Moore,et al.  The unrecognized epidemic of blunt carotid arterial injuries: early diagnosis improves neurologic outcome. , 1998, Annals of surgery.

[21]  T. Fabian,et al.  Blunt carotid injury. Importance of early diagnosis and anticoagulant therapy. , 1996 .

[22]  J. J. Caro,et al.  The risks of death and of severe nonfatal reactions with high- vs low-osmolality contrast media: a meta-analysis. , 1991, AJR. American journal of roentgenology.