Denver criteria for blunt cerebrovascular injury

The Denver criteria are a set of screening criteria for blunt cerebrovascular injury (BCVI) in trauma used to reduce the need for CT angiography and its associated radiation exposure. 

The screening protocol criteria 1,3 for blunt cerebrovascular injury are divided into signs/symptoms and risk factors:

  • arterial hemorrhage
  • cervical bruit in patients <50 years of age
  • expanding cervical hematoma
  • focal neurologic deficit
  • neurologic exam incongruous with head CT scan findings
  • stroke on secondary CT scan

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If a trauma patient meets one or many of these criteria, the diagnosis of blunt cerebrovascular injury should be excluded with CTA or DSA. DSA is far more sensitive than 32-MDCT 4 but less readily available.

Wide variation exists in the literature regarding the effectiveness of the criteria. In a small retrospective study, a negative Denver criteria screening excluded blunt cerebrovascular injury in 99.8% of patients 2. Whereas a large systematic review and meta-analysis of more than 120,000 trauma patients found blunt cerebrovascular injury present in 20-22% of patients not meeting traditional screening criteria 5.

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rID: 41637
Section: Approach
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