Podcast 1019: Trauma Blunt Cardiovascular Injuries (BCVI)

The clinical approach to trauma imaging is shifting toward more frequent use of CT angiograms (CTA) of the neck to identify blunt cerebrovascular injuries (BCVI). While historically reserved for high-mechanism trauma or symptomatic patients, expanded screening aims to detect asymptomatic carotid or vertebral artery dissections that pose a significant risk for delayed, devastating strokes. The modified Denver criteria, developed at Denver Health, provide a framework for identifying high-risk indicators such as complex facial fractures and cervical spine injuries that warrant imaging. Additional risk factors include high rib fractures and medial clavicle fractures. While some trauma surgeons advocate for universal screening during initial neck or chest imaging, the primary goal remains early intervention through monitoring, aspirin, or anticoagulation to prevent clot formation and subsequent neurological deficits in patients who initially appear stable.