🧠 Blunt Cerebrovascular Injury Screening (Expanded Denver)
UseUse during trauma evaluation to identify patients who should undergo neck CTA based on BCVI signs/symptoms or…
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SourceBiffl WL, et al. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma 199…
Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Scene next step
📋neurovascularOpen scene pack →Score + version; reference only — not a substitute for care · no HIS write
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Methodology · worked example, guidelines & full notes
Clinical takeaway
BCVI stroke risk is [pending update]highest early after injury, so proactive screening of high-risk mechanisms matters even when the patient is asymptomatic. (original synthesis · not guideline verbatim)
When to use
Use during trauma evaluation to identify patients who should undergo neck CTA based on BCVI signs/symptoms or high-risk injury mechanisms, since most BCVI is initially asymptomatic.
How it works
Screen positive if any BCVI sign/symptom OR any high-risk factor is present → neck CTA recommended. Signs/symptoms drive a high-priority (emergent imaging) pathway; risk factors alone drive a screening pathway.
Key points
- BCVI stroke risk is [pending update]highest early after injury, so proactive screening of high-risk mechanisms matters even when the patient is asymptomatic. (original synthesis · not guideline verbatim)
- Confirmed BCVI is usually treated with antithrombotic therapy, balanced against bleeding risk from concomitant TBI, solid-organ, or pelvic injury.
- The expanded Denver criteria can still miss cases; some centers screen more liberally.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| BCVI signs/symptoms (any): arterial bleeding from neck/nose/mouth, cervical bruit (<50 yr), expanding cervical hematoma, focal neurologic deficit (TIA/hemiparesis/Horner/vertebrobasilar), deficit incongruent with head CT, ischemic stroke on CT/MRI | None |
|---|---|
| Risk factors (high-energy mechanism + any): Le Fort II/III, mandible fracture, skull-base/complex skull fracture, cervical spine fracture (esp. C1–3/transverse-foramen/subluxation), DAI or GCS <6, near-hanging with hypoxia, seatbelt/clothesline-type neck injury, scalp degloving, great-vessel chest injury | None |
→Screening recommendationScreening not currently needed
- Decision：No corresponding signs/symptoms or risk factors; proceed with standard trauma evaluation and re-assess dynamically if needed
- Significance：BCVI (blunt carotid/vertebral injury) carries a ~[pending update] stroke risk, highest within [pending update] of injury; most are initially asymptomatic, so high-risk mechanisms are screened proactively
- Management：Once confirmed, antithrombotic therapy (antiplatelet or anticoagulation) is usually given, weighing bleeding risk with trauma surgery (concomitant TBI/solid-organ/pelvic bleeding); follow by Biffl/Denver grade
| BCVI signs/symptoms (any): arterial bleeding from neck/nose/mouth, cervical bruit (<50 yr), expanding cervical hematoma, focal neurologic deficit (TIA/hemiparesis/Horner/vertebrobasilar), deficit incongruent with head CT, ischemic stroke on CT/MRI | ≥1 present |
|---|---|
| Risk factors (high-energy mechanism + any): Le Fort II/III, mandible fracture, skull-base/complex skull fracture, cervical spine fracture (esp. C1–3/transverse-foramen/subluxation), DAI or GCS <6, near-hanging with hypoxia, seatbelt/clothesline-type neck injury, scalp degloving, great-vessel chest injury | ≥1 present |
→Screening recommendationNeck CTA recommended
- Decision：Signs/symptoms or risk factors present → neck CT angiography (CTA) recommended to screen for BCVI; with signs/symptoms, obtain emergent imaging and treat bleeding/stroke early
- Significance：BCVI (blunt carotid/vertebral injury) carries a ~[pending update] stroke risk, highest within [pending update] of injury; most are initially asymptomatic, so high-risk mechanisms are screened proactively
- Management：Once confirmed, antithrombotic therapy (antiplatelet or anticoagulation) is usually given, weighing bleeding risk with trauma surgery (concomitant TBI/solid-organ/pelvic bleeding); follow by Biffl/Denver grade
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Blunt Cerebrovascular Injury Screening (Expanded Denver)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Blunt Cerebrovascular Injury Screening (Expanded Denver) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Blunt Cerebrovascular Injury Screening (Expanded Denver) calculated in practice? Can you show a worked example?
- Inputs: BCVI signs/symptoms (any): arterial bleeding from neck/nose/mouth, cervical bruit (<50 yr), expanding cervical hematoma, focal neurologic deficit (TIA/hemiparesis/Horner/vertebrobasilar), deficit incongruent with head CT, ischemic stroke on CT/MRI None, Risk factors (high-energy mechanism + any): Le Fort II/III, mandible fracture, skull-base/complex skull fracture, cervical spine fracture (esp. C1–3/transverse-foramen/subluxation), DAI or GCS <6, near-hanging with hypoxia, seatbelt/clothesline-type neck injury, scalp degloving, great-vessel chest injury None → Result: Screening recommendation Screening not currently needed（Decision: No corresponding signs/symptoms or risk factors; proceed with standard trauma evaluation and re-assess dynamically if needed, Significance: BCVI (blunt carotid/vertebral injury) carries a ~[pending update] stroke risk, highest within [pending update] of injury; most are initially asymptomatic, so high-risk mechanisms are screened proactively, Management: Once confirmed, antithrombotic therapy (antiplatelet or anticoagulation) is usually given, weighing bleeding risk with trauma surgery (concomitant TBI/solid-organ/pelvic bleeding); follow by Biffl/Denver grade） Inputs: BCVI signs/symptoms (any): arterial bleeding from neck/nose/mouth, cervical bruit (<50 yr), expanding cervical hematoma, focal neurologic deficit (TIA/hemiparesis/Horner/vertebrobasilar), deficit incongruent with head CT, ischemic stroke on CT/MRI ≥1 present, Risk factors (high-energy mechanism + any): Le Fort II/III, mandible fracture, skull-base/complex skull fracture, cervical spine fracture (esp. C1–3/transverse-foramen/subluxation), DAI or GCS <6, near-hanging with hypoxia, seatbelt/clothesline-type neck injury, scalp degloving, great-vessel chest injury ≥1 present → Result: Screening recommendation Neck CTA recommended（Decision: Signs/symptoms or risk factors present → neck CT angiography (CTA) recommended to screen for BCVI; with signs/symptoms, obtain emergent imaging and treat bleeding/stroke early, Significance: BCVI (blunt carotid/vertebral injury) carries a ~[pending update] stroke risk, highest within [pending update] of injury; most are initially asymptomatic, so high-risk mechanisms are screened proactively, Management: Once confirmed, antithrombotic therapy (antiplatelet or anticoagulation) is usually given, weighing bleeding risk with trauma surgery (concomitant TBI/solid-organ/pelvic bleeding); follow by Biffl/Denver grade）