Shibahashi et al reported a nomogram that help to predict the probability of blunt cerebrovascular injury. This can help to identify a patient who may require a more complete evaluation. The authors are from Tokyo Metropolitan Bokutoh Hospital and Chiba University in Japan.
Patient selection: blunt trauma
Parameters:
(1) sex
(2) high speed impact
(3) hypotension on arrival at trauma center
(4) Glasgow coma scale (GCS)
Parameter |
Finding |
Points |
sex |
female |
0 |
|
male |
20.9 |
high speed impact |
no |
0 |
|
yes |
15 |
hypotension |
no |
0 |
|
yes |
48.2 |
Glasgow coma scale |
3 to 8 |
80.2 |
|
9 to 15 |
0 |
injury to face |
no |
0 |
|
yes |
33.3 |
injury to neck |
no |
0 |
|
yes |
63.8 |
injury to spine |
no |
0 |
|
yes |
96.6 |
injury to lower extremity |
no |
45.2 |
|
yes |
0 |
supratentorial subdural |
no |
41.8 |
|
yes |
0 |
skull base fracture |
no |
0 |
|
yes |
67.5 |
cervical spine fracture or subluxation |
no |
0 |
|
yes |
100 |
lumbar spine fracture or sublunxation |
no |
81.7 |
|
yes |
0 |
soft tissue injury to face |
no |
45.4 |
|
yes |
0 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 739.7
• The higher the score the greater the risk of cerebrovascular injury.
• The maximum risk reported is less than 50%.
value of X =
= (0.01245 * (score)) - 9.398
probability of cerebrovascular injury =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve according to the authors is 0.83 (higher if definition narrowed to carotid and vertebral arteries).
Specialty: Surgery, orthopedic