UMEM Educational Pearls

Category: Trauma

Title: How to identify blunt cervical vascular injuries

Keywords: Blunt neck trauma, Denver criteria, expanded Denver Criteria, cervical trauma (PubMed Search)

Posted: 1/29/2023 by Robert Flint, MD (Updated: 7/12/2024)
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Missing blunt cervical vascular injuries can lead to delayed catastrophic sequela such as stroke. Usie the epanded Denver criteria to help you identify these injuries.


Expanded Denver criteria for BCVI

-Signs/symptoms of BCVI

Potential arterial hemorrhage from neck/nose/mouth
Cervical bruit in patient less than 50 years old
Expanding cervical hematoma
Focal neurologic defect: TIA, hemiparesis, vertebrobasilar symptoms, Horner's syndrome
Neurologic deficit inconsistent with head CT
Stroke on CT or MRI

-Risk factors for BCVI

High-energy transfer mechanism
Displaced midface fracture (LeFort II or III)
Mandible fracture
Complex skull fracture/basilar skull fracture/occipital condyle fracture
Severe TBI with GCS less than 6
Cervical spine fracture, subluxation, or ligamentous injury at any level
Near hanging with anoxic brain injury
Clothesline type injury or seat belt abrasion with significant swelling, pain, or altered mental status
TBI with thoracic injuries
Scalp degloving
Thoracic vascular injuries
Blunt cardiac rupture
Upper rib fractures


Protect that Neck! Management of Blunt and Penetrating Neck Trauma  Julie La, MD, MESc Tim Chaplin, MD Chris Evans, MD :