View source for EBQ:Denver Screening Criteria

{{Denver screening criteria background}}

==Clinical Question==
*Can clinical criteria and injury profile and risk factors successfully identify patients at risk for BCVI?

==Conclusion==
Denver criteria can successfully identify trauma patients at risk for vascular injury.
*5% of trauma patients were screened
*18% of screened patients had a vascular injury
{{Denver Screening Criteria}}


*Kerwin et al: Using the above criteria for both symptomatic and asymptomatic patients, found a 44% positive angiography rate in 1941 patients.<ref>Kerwin AJ, Bynoe RP, Murray J et al. Liberalized screening for blunt carotid and vertebral artery injuries is justified. J. Trauma 2001; 51: 308–14.</ref>
*Fabian et al: Reported a drop in BCI-associated mortality from 24% to 13% after instituting a broad screening protocol.<ref>Fabian TC, Patton JH, Croce MA et al. Blunt carotid injury: importance of early diagnosis and anticoagulant therapy. Ann. Surg.1996; 223: 513–25.</ref>

==Major Points==
*The Denver Screening Criteria identify trauma patients at risk for blunt cerebrovascular injury (BCVI)
*Screening 5% of all trauma patients using clinical criteria captured 18% with confirmed vascular injury
*Early identification of BCVI allows initiation of antithrombotic therapy to prevent devastating stroke
*Implementation of screening protocols has been associated with reduced BCVI-related mortality

==Study Design==
*Prospective, single-center observational study
*Denver Health Medical Center, Level I Trauma Center
*Screening criteria applied to all blunt trauma patients presenting to the ED
*Positive screening triggered 4-vessel cerebral angiography

==Population==
===Inclusion Criteria===
*All blunt trauma patients presenting to the trauma center
*Patients meeting one or more Denver screening criteria
===Exclusion Criteria===
*Penetrating trauma
*Patients who died before screening could be completed

==Interventions==
*No therapeutic intervention; this was a screening accuracy study
*Patients meeting Denver criteria underwent 4-vessel cerebral angiography
*Positive patients received antithrombotic therapy (heparin or antiplatelet agents)

==Outcomes==
*5% of all trauma patients met screening criteria
*18% of screened patients had confirmed vascular injury on angiography
*Kerwin et al validation: 44% positive angiography rate in 1,941 patients using liberalized criteria
*Fabian et al: BCVI-associated mortality decreased from 24% to 13% after instituting screening

==Criticisms==
*The Denver Criteria have not been externally validated in a large multicenter study
*CTA has largely replaced conventional angiography for screening, and the criteria were developed in the angiography era
*Sensitivity of the criteria is unknown; some BCVI may be missed in patients not meeting screening criteria
*Optimal antithrombotic treatment protocol for identified BCVI remains debated
*The Memphis criteria provide an alternative screening tool with similar variables

==Funding==
*None reported

==Validation==
*The Denver Criteria has not been externally validated
*'''The Memphis Criteria''' which includes many of the same criteria screened 3.9% of patients and found an incidence of 29% vascular injury in screened patients.
** Cervical Spine Fracture
**Neuro deficit not explained by brain imaging
**Horner's Syndrome
**Leforte 2 or 3 fracture
**Basilar Skull Fracture involving the carotid Canal
**Seatbelt Sign
**Neck Hematoma
**Hanging Mechanism

==See Also==
*[[Blunt neck trauma]]
*[[Vertebral and carotid artery dissection]]

==Sources==
<references/>

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