Screening for BCVI is ideally performed to appropriately initiate anticoagulation therapy prior to the patient developing neurologic deficits. While there are no universally accepted criteria for guiding imaging evaluation for BCVI, the high sensitivity and excellent negative predictive value of the revised Denver criteria make it a reasonable set of criteria when screening blunt trauma patients for BCVI. The Denver screening criteria was first proposed in 1994 and subsequently revised in 2004 [63] and 2011 [65]. Under the revised Denver criteria, cerebrovascular imaging is indicated in any patient who has one of the signs or symptoms of BCVI or one of the risk factors for BCVI (Table 5). Beliaev et al [69] in 2014 validated the revised Denver criteria, finding 97% sensitivity for detecting BCVI with negative predictive value of 99.6%. Geddes et al [64] compared incidence of BCVI before and after introduction of the revised Denver protocol and found an incidence of BCVI of 2.99% in blunt trauma patients after implementation of the revised Denver protocol compared with an incidence of 2.36% prior to use of the Denver protocol, which suggests that the protocol finds a significant number of cases of BCVI compared with prior screening methods. Geddes et al [64] also noted that use of the revised Denver protocol resulted in 29% more BCVIs identified in asymptomatic blunt trauma patients compared with their prior screening criteria. Suspected Spine Trauma CTA Head and Neck In the past two decades, CTA has seen a dramatic improvement in both speed of image acquisition and resolution. This has resulted in significant improvement in the ability of CTA to detect cervical vascular injuries.
Suspected Spine Trauma PCAs. Screening for BCVI is ideally performed to appropriately initiate anticoagulation therapy prior to the patient developing neurologic deficits. While there are no universally accepted criteria for guiding imaging evaluation for BCVI, the high sensitivity and excellent negative predictive value of the revised Denver criteria make it a reasonable set of criteria when screening blunt trauma patients for BCVI. The Denver screening criteria was first proposed in 1994 and subsequently revised in 2004 [63] and 2011 [65]. Under the revised Denver criteria, cerebrovascular imaging is indicated in any patient who has one of the signs or symptoms of BCVI or one of the risk factors for BCVI (Table 5). Beliaev et al [69] in 2014 validated the revised Denver criteria, finding 97% sensitivity for detecting BCVI with negative predictive value of 99.6%. Geddes et al [64] compared incidence of BCVI before and after introduction of the revised Denver protocol and found an incidence of BCVI of 2.99% in blunt trauma patients after implementation of the revised Denver protocol compared with an incidence of 2.36% prior to use of the Denver protocol, which suggests that the protocol finds a significant number of cases of BCVI compared with prior screening methods. Geddes et al [64] also noted that use of the revised Denver protocol resulted in 29% more BCVIs identified in asymptomatic blunt trauma patients compared with their prior screening criteria. Suspected Spine Trauma CTA Head and Neck In the past two decades, CTA has seen a dramatic improvement in both speed of image acquisition and resolution. This has resulted in significant improvement in the ability of CTA to detect cervical vascular injuries.