Blunt Cerebrovascular Injury: Are We Overscreening Low-Mechanism Trauma?

BACKGROUND AND PURPOSE: Screening patients with trauma for blunt cerebrovascular injury with neck CTA is a common practice, but there remains disagreement regarding which patients should be screened. We reviewed adult blunt cerebrovascular injury data from a level 1 trauma center to investigate whether screening is warranted in low-mechanism trauma. MATERIALS AND METHODS: We reviewed all neck CTAs performed on adult trauma patients in the emergency department during the 2019 calendar year. Clinical and imaging risk factors for blunt cerebrovascular injury, trauma mechanism, initial neck CTA interpretations, results from subsequent CTA and DSA studies, antiplatelet and anticoagulant treatments, and outcome data were recorded. RESULTS: One thousand one hundred thirty-six neck CTAs met the inclusion criteria, of which 965 (85%) were interpreted as having negative findings; 125, as having indeterminate findings (11%); and 46, as having positive findings (4%). Review of subsequent imaging and clinical documentation led to classification of 40 indeterminate studies (32%) as true-positives and 85 (68%) as false-positives. Blunt cerebrovascular injury was identified in 77 (12.6%) cases meeting and in 9 (1.7%) cases not meeting the expanded Denver criteria. The subset of 204 low-mechanism trauma cases (ground-level falls, blunt assaults, and low-impact motor vehicle collisions) not meeting the expanded Denver criteria (18% of the entire data set) could have been excluded from screening with 1 questionable injury and 0 ischemic strokes missed and 12 false-positive cases prevented. CONCLUSIONS: We advocate reservation of blunt cerebrovascular injury screening in low-mechanism trauma for patients meeting the expanded Denver criteria. Further research is needed to determine the behavior of indeterminate cases and to establish criteria for separating true-positive from false-positive findings.

The Radiology Scholars Certificate Program: A Medical Education Learning Tool.

RATIONALE AND OBJECTIVES: The Radiology Scholars Certificate Program (RSCP) is an extracurricular program created for preclinical medical students to address disparities in radiology education and exposure during medical school. MATERIALS AND METHODS: The RSCP was designed as a year-long program for first- and second-year medical students. The 4 key components of the RSCP are: Exposure to radiology through shadowing, knowledge acquisition through self-paced case-based learning modules, knowledge application in interactive workshops, and completion of a scholarly project. Students are required to complete at least 3 hours of shadowing, attend at least 3 workshops, complete self-paced online modules, and complete a capstone project on a topic of their choosing. Pre- and post-program surveys were administered to assess trends in participants' perception of the field and imaging-related clinical knowledge. RESULTS: In the first year of the RSCP, 55% of the matriculating class enrolled and of those, 84% completed the program. Approximately half of participants were female. Participants demonstrated significant improvement in radiology knowledge, with average scores improving from 52.8% to 68.6% (p < .001) on the knowledge-related survey questions. Significant improvements were also observed in student-reported confidence with ordering and interpreting imaging studies and in their perceptions of the field. CONCLUSION: The RSCP is an effective tool for addressing deficits in radiology education and exposure during medical school. It is designed to be run by senior medical students under radiology resident and attending supervision. With motivated student and radiologist investment, the RSCP should be easily replicable in medical training programs worldwide.