Identifying Low-Risk Trauma Patients for Blunt Cerebrovascular Injury: Evidence From the North Carolina Trauma Registry

BackgroundBlunt cerebrovascular injury (BCVI) is a serious complication of blunt trauma with high rates of morbidity and mortality. There is evidence to support universal screening, but this raises concerns about cost, radiation exposure, and system burden. This study examined the connection between clinical factors at initial presentation and BCVI risk to identify opportunities to improve imaging utilization.MethodsWe analyzed patients with blunt injury from the North Carolina Trauma Registry (2016-2021). Blunt cerebrovascular injury was identified using ICD-10 codes. Clinical risk factors evaluated were low Glasgow Coma Score (GCS), significant supraclavicular injury (above-the-clavicle (ATC) injury), and trauma activation level. Logistic regression was used to identify predictors of BCVI.ResultsAmong 198 211 blunt trauma patients, 1336 (0.70%) were diagnosed with BCVI. The highest prevalence was among patients with both a low GCS and significant ATC injury (4.0%), followed by those with only ATC injury (1.5%). Only two cases (0.001%) occurred in patients with neither indicator. The adjusted odds ratios for BCVI were 3.0 (95% CI: 2.6-3.5) for low GCS and 2.8 (95% CI: 2.4-3.2) for level 1 trauma activation. Above-the-clavicle injury was nearly a perfect predictor of BCVI.ConclusionsPatients without altered mental status or significant injuries above the clavicle had an extremely low risk of BCVI. Although liberal screening strategies remain important to prevent missed injuries, our findings suggest that a clearly defined low-risk subgroup may not require routine CTA screening. Prospective, multicenter validation of contemporary screening criteria is needed to refine risk stratification and optimize cross-sectional imaging utilization.Level of EvidenceLevel III, Prognostic/Epidemiological.