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Table 2 Overview of clinical recommendations, strength, level of evidence and scientific rationale

From: Best practice guidelines for blunt cerebrovascular injury (BCVI)

Clinical question Recommendation Strength of recommendation Level of evidence Rationale (Benefits and harms)
What part of the trauma population should be screened for BCVI? Apply expanded Denver screening criteria Strong Low A documented screening tool ensures focus on the condition. Possible danger of overtriage and unnecessary use of imaging.
Which radiological method should be applied for screening? CTA has acceptable specificity and sensitivity. DSA remains gold standard Strong Moderate DSA is time consuming, invasive with potential complications and often not available 24–7. CTA is fast and available with lower complication risk. CTA has higher radiation exposure with a risk of false positive findings.
How should BCVI be treated? Early treatment with either LMWH or AP medication Strong Low Uncertainty of treatment effect. Studies show that early treatment is safe. Risk is worsening of existing hemorrhage.
Continue treatment with LMWH or AP for at least 3 months Strong Low Long term AP treatment is generally safe, but may cause side effects such as peptic ulcer.
Pseudoaneurysm or high-grade vessel injury may be considered for endovascular treatment Conditional Low May prevent new or recurrent stroke, but uncertainty of treatment effect or stent patency. Double platelet-inhibitors increases risk of hemorrhage in trauma patients.
How should patients with BCVI be handled over time? Perform re-imaging at 7 days and 3 months. Conditional Low Repeat imaging can confirm or discard the diagnosis of BCVI. Risk is radiation exposure.
  1. BCVI blunt cerebrovascular injury, CTA CT angiography, DSA digital subtraction angiography, LMWH low molecular weight heparin, AP anti-platelet