Blunt cerebrovascular injury after ground-level falls: Yield of CT angiography and relevance of the expanded Denver criteria.

Abstract

Blunt cerebrovascular injuries (BCVI) are nonpenetrating traumatic injuries to the carotid or vertebral arteries that can result in stroke. While the incidence of BCVI in admitted trauma patients is estimated at 1% to 2%, the risk specifically after ground-level falls (GLF) is not well described. Current screening practices vary, with some centers using criteria such as the expanded Denver criteria while others have adopted universal computed tomographic angiography (CTA) screening. This study aimed to quantify BCVI incidence following GLF and describe the distribution of BCVI by expanded Denver criteria in this population. A single-center retrospective cohort study was conducted at a regional Level I trauma center from 2016 to 2024. Adult GLF patients evaluated by the trauma team who underwent CTA at index trauma evaluation comprised the primary imaging cohort, with BCVI incidence as the primary outcome. Patients were stratified by expanded Denver criteria status. An administrative database separately identified GLF patients with a stroke diagnosis during the same hospitalization who underwent structured physician adjudication to determine BCVI attribution. Of 1,732 GLF patients with CTA performed, 1,045 met the inclusion criteria. BCVI was identified in 67 patients (6.4%), all of whom met expanded Denver criteria. Among Denver criteria-positive patients, BCVI was identified in 67/599 (11.2%), while none of the 446 criteria-negative patients had BCVI. Among 193 GLF patients with confirmed strokes adjudicated separately, none were BCVI-attributable. All identified BCVIs in this cohort occurred in patients meeting expanded Denver criteria, and no BCVIs were identified among criteria-negative patients. Among 193 adjudicated stroke patients, none were BCVI-attributable. Strict application of expanded Denver criteria would have avoided 446 CTAs in criteria-negative patients, supporting its use as a resource-conscious selective screening strategy in GLF patients. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Diagnostic Study; Level III.