A Systematic Review and Meta-Analysis of Diagnostic Screening Criteria for Blunt Cerebrovascular Injuries
Top Cited Papers
- 31 March 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 214 (3), 313-327
- https://doi.org/10.1016/j.jamcollsurg.2011.11.012
Abstract
Background Despite progress in diagnosing and managing blunt cerebrovascular injury (BCVI), controversy remains regarding the appropriate population to screen. A systematic review of published literature was conducted to summarize the overall incidence of BCVI and the various screening criteria used to detect BCVI. A meta-analysis was performed to evaluate which screening criteria may be associated with BCVI. Goals were to confirm inclusion of certain criteria in current screening protocols and possibly eliminate criteria not associated with BCVI. Study Design Studies published between January 1995 and April 2011 using digital subtraction angiography or CT angiography as a diagnostic modality and reporting overall BCVI incidence or prevalence of BCVI for specific screening criteria were examined. Screening criteria were analyzed using a random effects model to determine if an association with BCVI was present. Results The incidence range of BCVI was between 0.18% and 2.70% among approximately 122,176 blunt trauma admissions. The meta-analysis encompassed 418 BCVI and 22,568 non-BCVI patients. Of the 9 screening criteria analyzed, cervical spine (odds ratio [OR] 5.45; 95% CI 2.24 to 13.27; p < 0.0001) and thoracic (OR 1.98; 95% CI 1.35 to 2.92; p = 0.001) injuries demonstrated a significant association with BCVI. Conclusions Patients with cervical spine and thoracic injuries had significantly greater likelihoods of BCVI compared with patients without these injuries. All patients with either injury should be screened for BCVI. Multivariate logistic regression analysis is needed to elucidate the possible impact of the combined presence of screening criteria, but it was not possible in our study due to limitations in data presentation. Standardized reporting of BCVI data is not established and is recommended to permit future collaboration.Keywords
This publication has 57 references indexed in Scilit:
- Blunt Cerebrovascular Injury Screening With 32-Channel Multidetector Computed TomographyAnnals of Surgery, 2011
- Cerebrovascular Dissections: A Review. Part II: Blunt Cerebrovascular InjuryNeurosurgery, 2011
- Blunt cerebrovascular traumaCurrent Opinion in Critical Care, 2010
- Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteriaScandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2010
- Screening for blunt cerebrovascular injury: selection criteria for use of angiographyJournal of Neurosurgery, 2010
- A multivariate logistic regression analysis of risk factors for blunt cerebrovascular injuryJournal of Vascular Surgery, 2010
- Evaluation of the criteria for angiotomography indications in the diagnosis of carotid and vertebral arterial injury associated with blunt traumaWorld Journal of Emergency Surgery, 2010
- BLUNT CEREBROVASCULAR INJURY: AN EVALUATION FROM A MAJOR TRAUMA CENTREAnz Journal of Surgery, 2007
- Computed Tomographic Angiography for the Diagnosis of Blunt Cervical Vascular Injury: Is It Ready for Primetime?The Journal of Trauma and Acute Care Surgery, 2006
- Blunt Carotid Artery InjuriesThe Journal of Trauma and Acute Care Surgery, 1999