The modified Denver criteria is a screening rule for identifying patients at risk of having a cerebrovascular injury after blunt trauma.
If any of the above are present, stable patients should undergo CT angiogram of the head and neck to evaluate for cervical artery dissection.
Other criteria which may warrant CT angiogram to evaluate for BCVI include GCS ≤ 8 (East Trauma guidelines, level 3 rec.) and seatbelt sign above the clavicle resulting in significant swelling or altered mental status (Biffl et al).
Ultrasound is not recommended for identification of these injuries as they often occur as the vessels enter the skull base, too high for ultrasound access (sens. 38-86%).
Bromberg WJ, et al. Blunt Cerebrovascular Injury Practice Management Guidelines: The Eastern Association for the Surgery of Trauma. J Trauma. 2010; 68(2): 471-7.
Biffl WL, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999; 178: 517–22.
Cothren CC, et al. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004; 139: 540–5.