| Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. | |
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MedLine Citation:
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PMID: 20154559 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Blunt injury to the carotid or vertebral vessels (blunt cerebrovascular injury [BCVI]) is diagnosed in approximately 1 of 1,000 (0.1%) patients hospitalized for trauma in the United States with the majority of these injuries diagnosed after the development of symptoms secondary to central nervous system ischemia, with a resultant neurologic morbidity of up to 80% and associated mortality of up to 40%. With screening, the incidence rises to 1% of all blunt trauma patients and as high as 2.7% in patients with an Injury Severity Score of >or=16. The Eastern Association for the Surgery of Trauma organization Practice Management Guidelines committee set out to develop an EBM guideline for the screening, diagnosis, and treatment of BCVI. METHODS: A computerized search of the National Library of Medicine/National Institute of Health, Medline database was performed using citations from 1965 to 2005 inclusive. Titles and abstracts were reviewed to determine relevance, and isolated case reports, small case series, editorials, letters to the editor, and review articles were eliminated. The bibliographies of the resulting full-text articles were searched for other relevant citations, and these were obtained as needed. These papers were reviewed based on the following questions: 1. What patients are of high enough risk, so that diagnostic evaluation should be pursued for the screening and diagnosis of BCVI? 2. What is the appropriate modality for the screening and diagnosis of BCVI? 3. How should BCVI be treated? 4. If indicated, for how long should antithrombotic therapy be administered? 5. How should one monitor the response to therapy? RESULTS: One hundred seventy-nine articles were selected for review, and of these, 68 met inclusion criteria and are excerpted in the attached evidentiary table and used to make recommendations. CONCLUSIONS: The East Practice Management Guidelines Committee suggests guidelines that should be safe and efficacious for the screening, diagnosis, and treatment of BCVI. Risk factors for screening are identified (see ), screening modalities are reviewed indicating that although angiography remains the gold standard, multi-planar (>or==8 slice) CT angiography may be equivalent, and treatment algorithms are evaluated. It is noted that change in the diagnosis and management of this injury constellation is rapid due to technological advancement and the difficulties inherent in performing randomized prospective trials in this patient population. |
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Authors:
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William J Bromberg; Bryan C Collier; Larry N Diebel; Kevin M Dwyer; Michelle R Holevar; David G Jacobs; Stanley J Kurek; Martin A Schreiber; Mark L Shapiro; Todd R Vogel |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of trauma Volume: 68 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-02-15 Completed Date: 2010-04-01 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
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Languages: eng Pagination: 471-7 Citation Subset: AIM; IM |
Affiliation:
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Memorial Health University Medical Center, Savannah, Georgia 31404, USA. brombwi1@memorialhealth.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Carotid Artery Injuries / diagnosis, epidemiology Child Fibrinolytic Agents / therapeutic use Humans Injury Severity Score Magnetic Resonance Angiography Practice Guidelines as Topic* Risk Assessment Sensitivity and Specificity Stents Vertebral Artery / injuries* Wounds, Nonpenetrating / diagnosis*, surgery, therapy* |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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