The relationship between blunt trauma and damage to the cerebrovascular circulation of the head and neck has been widely reported [1]. The benefits of both screening the population at risk of these injuries, and the subsequent treatment of subclinical injuries has been well established [2]. The expected rate of blunt cerebrovascular injury (BCVI) is between 1% and 2.70% of patients with blunt trauma [3]. At Auckland City Hospital, the regional trauma center for the greater Auckland region, there was a suspicion of underdetection of BCVI...

Using the Auckland City Hospital Trauma Registry, the population of patients presenting with blunt trauma were assessed over a 13 year span from 2003-2016. Data was collected frompatients who presented with blunt trauma to the head, neck and/or chest. Basic demographics gathered, which were available from the Trauma Registry. The primary outcome was defined as comparative rates of BCVI, which had been recorded in the registry, and BCVI induced stroke. Secondary outcomes were gathered on the cases of BCVI: – Method of diagnosis (CTA, MRA,...

Primary outcomes: There were total of 4767 patients included in the 'prior to the protocol change' group, and 999 in the after the change group (total n=5766). Prior to protocol change, there was a BCVI rate of 27/4767, which at 0.57% is below the expected rates of 1-2.7%. After initiation of the protocol, the BCVI rate increased to 13/999, giving a rate of 1.30%. The differences in these primary endpoints were statistically significant (p=0.01). Pre-protocol Post-protocol BCVI 27 13 40 Non BCVI 4740 986 5726...

This study demonstrated a significant increase in the rate of BCVI diagnosis following the initiation of a screening protocol. There was also a significant decrease in residual neurology or death in those patients diagnosed with BCVI following initiation of the protocol. The proportion of patients that received treatment (85% in the post-protocol group) confirms that a correctdiagnosis in these cases is a useful tool for clinicians in management of these often-complicated patients. Of note, a significant proportion of the BCVI subgroup in the pre-protocol change...

Dr William Ormiston, Radiology Registrar, Auckland City Hospital, New Zealand Dr Lucy Modahl, Radiologist, Auckland City Hospital, New Zealand

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