BCVI 2021

Edmonton Zone Trauma Blunt Cerebrovascular Injury (BCVI) Screening Protocol (2021 Update) The following screening criteria have been implemented to identify blunt traumatic injuries to the carotid and vertebral arteries that can lead to stroke in 20% of affected patients if left untreated. The majority of strokes occur following hospital admission but within 72 hours of injury, justifying early screening and prevention in at-risk but initially asymptomatic trauma patients.

1. Who to Screen – High risk blunt mechanism* plus one or more of the following: a. C1-3 fractures b. Foramen transversarium fractures (C6 and above) c. C-Spine facet fracture, dislocation, or subluxation d. High energy direct blow to the neck i.e. Clothesline, seatbelt bruise over anterior neck e. Near-hanging injury with anoxia f. LeFort II/III facial fractures g. High risk skull base fractures (i.e. complex pattern, significant displacement, or in vicinity of the carotid canal) h. Focal neurologic deficit unexplained by imaging i. Closed head injury with GCS<6 without clear etiology on CT head *High risk blunt mechanism: MVC >50km/h or ejection, pedestrian/cyclist struck by vehicle >30km/h, fall >3 feet or 5 stairs, recreational vehicle rollover, near-hanging, direct blow to anterior neck.

2. How to Screen – CTA (minimum 64 slice) a. Patient must be completely still for the CTA (sedatives may be required) 3. When to Screen – early diagnosis is critical to stroke prevention, however, logistical challenges will limit the ability to scan all patients on arrival. a. If screening criteria are identified prior to or during the initial trauma CT scan, then CTA neck may be added to the initial CT at the discretion of the trauma surgeon on call. b. If not considered high risk for injury, or in the setting of major contra-indications to treatment (i.e. antithrombotic therapy), or if screening criteria are identified late, then may delay scan up to 24 hours.

4. Notes - This protocol does not replace clinical judgement, but is meant to expedite and limit variability of care. Some patients will require screening outside of these criteria, particularly if they meet multiple separate low risk criteria that are not included here. Symptomatic patients (i.e signs of arterial neck hemorrhage or acute stroke) also require CTA imaging but fall outside of this protocol.