Screening for and Treatment of Blunt
Cerebrovascular Injuries Algorithm

Historic Perspective

Blunt carotid injury (BCI) and blunt vertebral injury, collectively known as BCVI, have historically been considered rare, but potentially devastating, events. Early multicenter reviews collectively reported BCI-related mortality rates of 23%, with 48% of survivors suffering permanent severe neurologic sequelae.^1–4 In these reviews, the collective incidence of BCI was noted to be 0.1% among blunt trauma victims admitted to trauma centers. In the latter part of the 1990s, with awareness heightened by the landmark series from Memphis,⁵ the reported incidence of BCI increased to 0.24%–0.4%.^5–7 The Denver group confirmed that many injuries were clinically occult⁸ and instituted liberal screening of asymptomatic patients in the mid- 1990s.⁹ Screening for BCVI has now become widespread, and several centers have reported an incidence of BCVI exceeding 1% of blunt trauma admissions.^10–15