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. 

Screening criteria

The screening protocol criteria 1,3 for BCVI are divided into signs and symptoms of BCVI and risk factors:

Signs and symptoms
  • arterial hemorrhage
  • cervical bruit in patient <50 years of age
  • expanding cervical hematoma
  • focal neurologic deficit
  • neurologic exam incongruous with head CT scan findings
  • stroke on secondary CT scan
Risk factors include high-energy transfer mechanism with

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

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

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rID: 41637
Section: Approach
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