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 3Â 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 7Â days and 3Â months. | Conditional | Low | Repeat imaging can confirm or discard the diagnosis of BCVI. Risk is radiation exposure. |