Association Between Denver Criteria Count and Blunt Cerebrovascular Injury

Blunt cerebrovascular injuries (BCVI) are serious complications of blunt trauma, and screening is commonly guided by the Denver criteria. Although the presence of a single criterion is usually sufficient to justify CT angiography, some patients are imaged despite having no Denver criteria based on clinician judgment. The prevalence of BCVI in this population, as well as the cumulative effect of the number of Denver criteria on true BCVI risk, remains unclear. This study aimed to evaluate the association between the number of Denver criteria and the prevalence of BCVI.

We conducted a retrospective study at the Hôpital du Sacré-Cœur de Montréal, a tertiary trauma center (65,000 annual visits, including 3,000 trauma) in Canada. Patients aged ≥16 years with a blunt trauma between October 2023 and June 2024 who underwent CT angiography for suspected BCVI were included. The primary outcome was the presence of BCVI on CT angiography. Descriptive analyses were performed using means (95% CI) or counts (percentages). A logistic regression was used to assess the association between the number of Denver criteria and the presence of a BCVI. Including over 113 patients would grant us 80% power to detect an odds ratio of 0.5 (~18% vs 10% prevalence) using a two-sided alpha of 0.05.

Among 178 potentially eligible patients, 137 were included (mean age: 55 years; male: 93%); of whom 23 (17%) had a BCVI. Among 112 patients with at least one Denver criterion, 19 (17%) had BCVI, compared with 4 of 25 patients (16%) without any criteria (p=0.91). No significant association was observed between the number of Denver criteria and BCVI (odds ratio [OR] 1.45, 95% CI 0.99–2.12; p=0.060). BCVI prevalence remained relatively stable among patients with 0–3 criteria (0: 16%; 1: 14%, OR 0.86 [95% CI 0.23–3.16]; 2: 14%, OR 0.88 [95% CI 0.21–3.65]; 3: 20%, OR 1.31 [95% CI 0.25–6.88]). In contrast, BCVI prevalence approached statistical significance among patients with ≥4 criteria (60%, OR 7.88 [95% CI 0.98–63.31]).

BCVI prevalence was similar in patients with or without Denver criteria, and no clear association was demonstrated between the number of criteria and BCVI. These findings support the continued importance of clinical judgment in BCVI screening decisions.