Denver screening criteria
- Used to screen for vertebral and carotid artery dissection and/or injury after blunt head and neck trauma (BCVI - blunt cerebrovascular injury)
- A CTA to evaluate for VAI should be obtained in those meeting the modified Denver Criteria
- BCVI has the highest association with cervical hyperextension and rotation, hyperflexion, or direct blunt force to head and neck
- Most injuries are diagnosed after the development of symptoms secondary to central nervous system ischemia resulting in neurologic morbidity of up to 80% and associated mortality of up to 40%.
The Denver Screening Criteria are divided into risk factors and signs and symptoms
Signs and Symptoms
- Focal neurologic deficit
- Arterial Hemorrhage
- Cervical Bruit or Thrill (<50yo)
- Infarct on Head CT
- Expanding Neck Hematoma
- Neuro exam inconsistent with Head CT
- Midface Fractures
- Cervical Spine Injuries
- Basilar Skull Fracture
- Hanging with Anoxic Brain Injury
- Seat belt abrasion or other soft tissue injury of the anterior neck resulting in significant swelling or altered mental status
- Bromberg, William. et al. Blunt Cerebrovascular Injury Practice Management Guidelines: The Eastern Association for the Surgery of Trauma. J Trauma. 68 (2): 471-7, Feb 2010.
- Cothren CC, Moore EE, Biffl WL, et al. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004;139:540–545; discussion 545–546. PDF
- Biffl WL, Moore EE, Offner PJ, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178:517–522.
- Davis JW, Holbrook TL, Hoyt DB, Mackersie RC, Field TO Jr, Shackford SR. Blunt carotid artery dissection: incidence, associated injuries, screening, and treatment. J Trauma. 1990;30:1514–1517
- DiPerna CA, Rowe VL, Terramani TT, et al. Clinical importance of the “seat belt sign” in blunt trauma to the neck. Am Surg. 2002;68:441–445
- Rozycki GS, Tremblay L, Feliciano DV, et al. A prospective study for the detection of vascular injury in adult and pediatric patients with cervicothoracic seat belt signs. J Trauma. 2002;52:618–623; discussion 623–624