Berne et al evaluated patients with blunt trauma with a high risk mechanism for cerebrovascular injury. These can help to identify a patient who should undergo multi-detector computed tomography angiography (MDCT-A). The authors are from East Texas Medical Center in Tyler.


Patient selection: blunt trauma with high risk mechanism (high speed deceleration, direct blow to cervical region, hanging)


Outcome: performance of MDCT-A to detect vascular injury


The authors developed multivariate logistic regression models for blunt injury to internal carotid artery, blunt vertebral artery and both.


Risk factors for blunt cerebrovascular injury (both internal carotid and vertebral arteries):

(1) cervical spine injury (odds ratio 7.5)

(2) mandibular fracture (odds ratio 2.6)

(3) basilar skull fracture (odds ratio 1.8)

(4) Glasgow coma score <=8 in the ED

(5) elevated Injury Severity Score (ISS)


The ISS had an odds ratio of 1.05 per point. The mean ISS for patients without vascular injury was 12.7. The mean ISS for patients with vascular injury was 28.9. An ISS >= 16 should have an odds ratio of 2.2.


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