Diagnostic yield and clinical predictors of blunt cerebrovascular injury: A CTA utilization review at a level I trauma center.

PURPOSE: Blunt cerebrovascular injury (BCVI) is a potentially devastating complication of high-energy trauma that can lead to ischemic stroke if undetected. Computed tomography angiography (CTA) is the primary screening modality, though optimal patient selection criteria remain debated. Rising CTA utilization at our institution prompted a quality improvement review to evaluate the diagnostic yield and identify clinical predictors of BCVI.

METHODS

A retrospective review was conducted of trauma patients who underwent CTA of the head and neck at a Level I trauma center between January and December 2023.Clinical variables were compared between patients with and without BCVI on univariate analysis, and independent predictors were identified using multivariate logistic regression.

RESULTS

Among 305 patients screened, BCVI was identified in 40 patients (13.1%), with a total of 44 injuries due to multivessel involvement in 4 patients. Vertebral artery injuries predominated (34/44,77.3%), with Grade 1 being most common (18/44,40.9%). Loss of consciousness (OR 2.96; 95% CI 1.43-6.29; p = 0.003) and cervical spine fracture (OR 8.06; 95% CI 3.86-17.9; p < 0.001) were independent predictors of BCVI on multivariate analysis. The multivariate model demonstrated good discriminatory performance (AUROC = 0.788; 95% CI 0.707-0.868).

CONCLUSIONS

In a screened trauma cohort, LOC at the scene was a strong independent predictor of BCVI, a relationship not previously incorporated into formal screening criteria. These findings support prospective evaluation of LOC as a clinically accessible adjunct to existing risk-stratification tools.