II. Indications
- Determine need for CT Angiogram of Neck Vascular Injury in Blunt Force Trauma
III. Criteria: Signs and symptoms of Blunt Cerebrovascular Injury
- Suspected Arterial Hemorrhage from the neck or face
- Cervical Bruit in age <50 years
- Expanding neck Hematoma
- Focal neurologic deficits that do not correlate with Head CT findings
- Focal neurologic deficit correlating to CNS injury (e.g. TIA, Hemiparesis, Horner Syndrome, vertebrobasilar symptoms)
- Cerbrovascular accident on CT Imaging
IV. Criteria: Risk Factors for Blunt Cerebrovascular Injury
- High energy mechanism of injury
- Displaced Le Fort II or III mid-face Fractures
- MandibleFracture
- Cervical Spine Fractures (including subluxations)
- Basilar Skull Fracture and involvement of carotid canal
- Complex Skull Fracture
- Occipital condyle Fracture
- Other risks
- Traumatic Brain Injury or Diffuse Axonal Injury with GCS <6
- Scalp degloving
- Near hanging with anoxic brain injury
- Seat Belt Sign (or other soft tissue neck injury such as clothesline injury)
- Especially if significant associated significant swelling or Altered Level of Consciousness
- Blunt cardiac rupture
- Thoracic Injury with associated brain injury or vascular injury
- Cervical Fracture involving transverse process (associated with Vertebral Artery injury)
- Upper Rib Fractures (esp. first Rib Fracture)
- Medial Clavicle Fracture (not part of Denver criteria)
- May consider imaging due to excessive Whiplash-type force
V. References
- Shoenberger and Inaba (2026) BCVI, EM:Rap, 8/10/2026
- Kalsi, Kaufman and Hudson (2018) Crit Dec Emerg Med 32(10): 3-10
- Biffl (1999) J Trauma 47(5):845-53 +PMID:10568710 [PubMed]
- Biffl (1999) Am J Surg 178(6):517-22 +PMID:10670864 [PubMed]