denver criteria for blunt cerebrovascular injury

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The Denver criteria are a set of screening criteria used to determine when CT angiography of the neck is indicated to detect blunt cerebrovascular injury (BCVI) in trauma patients.

Screening criteria

The Denver criteria were initially developed in 1996 , modified in 2005 to limit the types of cervical spine injuries that qualify , and expanded in 2012 to include additional craniofacial, brain, and thoracic injuries . Subsequently, the Denver criteria have been further expanded to include again all cervical spine fractures .

The current screening protocol criteria are divided into signs/symptoms of blunt cerebrovascular injury and risk factors:

Signs and symptoms

potential arterial hemorrhage from the neck, nose, or mouth
cervical bruit in patients <50 years of age
expanding cervical hematoma
focal neurologic deficit (transient ischemic attack, hemiparesis, vertebrobasilar symptoms, Horner syndrome)
neurologic deficit incongruous with head CT findings
stroke on CT or MRI

Risk factors

High-energy transfer mechanism plus any of the following :

Le Fort II or III displaced midface fracture
mandible fracture
complex skull fracture (e.g., involving frontal bone and orbit)
base of skull fracture (sphenoid, petrous temporal, clivus, and occipital condyle fractures)
scalp degloving
cervical spine fracture, subluxation, or ligamentous injury at any level
severe traumatic brain injury with Glasgow coma scale <6
near hanging with hypoxic-ischemic (anoxic) brain injury
clothesline type injury or seat belt abrasion with significant swelling, pain, or altered mental status
traumatic brain injury with thoracic injuries
upper rib fractures
thoracic vascular injuries
blunt cardiac rupture

Management

If a trauma patient meets any of these criteria, the possibility of blunt cerebrovascular injury should be evaluated with multidetector-row, 64-channel CTA .

Patients diagnosed with blunt cerebrovascular injury should receive antithrombotic therapy (aspirin or heparin) to decrease the risk of stroke and stroke-related mortality .

History and etymology

The Denver criteria were developed by trauma surgeon Walter Biffl and surgical colleagues at Denver Health Medical Center in Colorado. Dr Biffl subsequently moved institutions, but the criteria have continued to be refined by colleagues in the Denver group and are featured in practice guidelines by various professional societies .