Best practice guidelines for blunt cerebrovascular injury (BCVI)

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Blunt cerebrovascular injury (BCVI) is a non-penetrating injury to the carotid and/or vertebral artery that may cause stroke in trauma patients. Historically BCVI has been considered rare but more recent publications indicate an overall incidence of 1–2% in the in-hospital trauma population and as high as 9% in patients with severe head injury. The indications for screening, treatment and follow-up of these patients have been controversial for years with few clear recommendations. In an attempt to provide a clinically oriented guideline for the handling of BCVI patients a working committee was created. The current guideline is the end result of this committees work. It is based on a systematic literature search and critical review of all available publications in addition to a standardized consensus process. We recommend using the expanded Denver screening criteria and CT angiography (CTA) for the detection of BCVI. Early antithrombotic treatment should be commenced as soon as considered safe and continued for at least 3 months. A CTA at 7 days to confirm or discard the diagnosis as well as a final imaging control at 3 months should be performed.

Electronic supplementary material

The online version of this article (10.1186/s13049-018-0559-1) contains supplementary material, which is available to authorized users.

Related collections

Most cited references 84

Record: found
Abstract: not found
Article: not found

AGREE II: advancing guideline development, reporting and evaluation in health care.

M. Brouwers, M E Kho, G P Browman … (2010)

0 comments Cited 1038 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature.

R Willinsky, Susan S. Taylor, Karel terBrugge … (2003)

To prospectively identify risk factors for neurologic complications related to cerebral angiography. A total of 2,899 consecutive cerebral digital subtraction angiograms obtained with nonionic contrast material were prospectively evaluated. Neurologic complications were categorized as transient ( 7 days). The neurologic complication rate was correlated with patient age, type of indication for catheter angiography, medical history, fluoroscopic time, number and size of catheters, type and number of vessels injected, operator experience, and the quartile in which the study was performed. The correlations were statistically analyzed with Fisher exact tests and a multiple logistic regression model. There were 39 (1.3%) neurologic complications in 2,899 procedures; 20 were transient (0.7%), five (0.2%) were reversible, and 14 (0.5%) were permanent. Neurologic complications were significantly more common in patients 55 years of age or older (25 of 1,361; 1.8%) (P =.035), in patients with cardiovascular disease (CVD) (20 of 862; 2.3%) (P =.004), and when fluoroscopic times were 10 minutes or longer (24 of 1,238; 1.9%) (P =.022). The neurologic complication rate was higher in procedures performed by fellows alone (24 of 1,878; 1.3%) compared with that when staff alone performed the procedures (three of 598; 0.5%), but the difference was not significant (P =.172). Neurologic complications were lower in the fourth quartile of the study (six of 171; 0.9%) compared with the first quartile (16 of 776; 2.1%), which was likely due to fewer patients being examined for carotid stenosis or ischemic stroke and fewer patients with CVD (P =.085). Age-related vascular disease accounted for the failure to lower the neurologic complication rate of cerebral angiography despite technical advances. Copyright RSNA, 2003

0 comments Cited 107 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Is Open Access

Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial.

Hugh S. Markus, Elizabeth Hayter, Christopher R Levi … (2015)

Extracranial carotid and vertebral artery dissection is an important cause of stroke, especially in young people. In some observational studies it has been associated with a high risk of recurrent stroke. Both antiplatelet drugs and anticoagulant drugs are used to reduce risk of stroke but whether one treatment strategy is more effective than the other is unknown. We compared their efficacy in the Cervical Artery Dissection in Stroke Study (CADISS), with the additional aim of establishing the true risk of recurrent stroke.

0 comments Cited 94 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Tor Brommeland:

ORCID: http://orcid.org/0000-0002-1137-2577

torbro@ous-hf.no

Eirik Helseth: ehelseth@ous-hf.no

Mads Aarhus: madaar@ous-hf.no

Kent Gøran Moen: kent.g.moen@ntnu.no

Stig Dyrskog: stig.dyrskog@gmail.com

Bo Bergholt: bo.bergholt@auh.rm.dk

Zandra Olivecrona: zandra.olivecrona@gmail.com

Elisabeth Jeppesen: elijep@ous-hf.no

Journal

Journal ID (nlm-ta): Scand J Trauma Resusc Emerg Med

Journal ID (iso-abbrev): Scand J Trauma Resusc Emerg Med

Title: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1757-7241

Publication date (Electronic): 29 October 2018

Publication date PMC-release: 29 October 2018

Publication date Collection: 2018

Volume: 26

Electronic Location Identifier: 90

Affiliations

[1 ]ISNI 0000 0004 0389 8485, GRID grid.55325.34, Department of Neurosurgery, , Oslo University Hospital Ullevål, ; Kirkeveien 166, 0450 Oslo, Norway

[2 ]ISNI 0000 0004 1936 8921, GRID grid.5510.1, Faculty of Medicine, , University of Oslo, ; Problemveien 7, 0315 Oslo, Norway

[3 ]ISNI 0000 0001 1516 2393, GRID grid.5947.f, Department of Neuromedicine and Movement Science, , Norwegian University of Science and Technology, ; Trondheim, Norway

[4 ]Department of Medical Imaging, Nord-Trondelag Health Trust, Levanger, Norway

[5 ]ISNI 0000 0004 0512 597X, GRID grid.154185.c, Department of Neurointensive care, , Aarhus University Hospital, ; Nørrebrogade 44, 8000 Aarhus, C, Denmark

[6 ]ISNI 0000 0004 0512 597X, GRID grid.154185.c, Department of Neurosurgery, , Aarhus University Hospital, ; Nørrebrogade 44, 8000 Aarhus, C, Denmark

[7 ]Department of Anestesia and Intensive care, Section for Neurosurgery, Faculty of Health and Medicine, Department for Medical Sciences, Södre Grev Rosengatan, 70185 Örebro, Sweden

[8 ]ISNI 0000 0004 0389 8485, GRID grid.55325.34, National Trauma Registry, Department of Research and Development, Division of Orthopedics, , Oslo University Hospital, ; NO-0424 Oslo, Norway

Author information

Tor Brommeland http://orcid.org/0000-0002-1137-2577

Article

Publisher ID: 559

DOI: 10.1186/s13049-018-0559-1

PMC ID: 6206718

PubMed ID: 30373641

SO-VID: b49dfddc-5106-447a-9b89-c33cb4a3264d

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.