{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:33:59Z","timestamp":1784248439928,"version":"3.55.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The Brain Injury Guidelines (BIG) provide neurosurgical consultation and imaging protocols by stratifying patients with traumatic brain injury (TBI) according to injury severity. However, the effect of concomitant blunt cerebrovascular injury (BCVI) on clinical progression and surgical intervention within this framework has not been investigated. The aim of this study was to determine whether the Biffl grade for BCVI evaluation should be incorporated into the BIG criteria to help determine clinical care, follow-up imaging, and treatment decisions for these patients.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Adult patients (age \u2265 18 years) with TBI who were transferred to a level 1 trauma center from 2019 to 2023 were retrospectively analyzed. For analysis, patients were stratified by BIG category and propensity matched (1:1) by age, sex, BIG classification, and frailty index. Clinical outcomes were compared between patients with and without BCVI. Multivariable logistic regression analysis was performed to identify predictors of clinical progression (radiographic injury progression or clinical neurological deterioration) or the need for neurosurgical intervention, both in the overall cohort and in the BCVI subgroup.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Overall, 999 patients (648 male, mean age 53.5 years) were included in this analysis, and 103 patients (10.3%) presented with BCVI in addition to TBI. The presence of BCVI was not independently associated with progression or the need for neurosurgical intervention in the overall cohort of patients with TBI or the matched cohort (103 patients with BCVI and 103 patients without BCVI). However, among patients with BCVI, both the presence of intracranial hemorrhage (OR 3.04, 95% CI 1.01\u20139.37) and an injury classified as Biffl grade > I (OR 4.00, 95% CI 1.46\u201310.96) significantly predicted progression or the need for intervention.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n For patients with TBI, BCVI alone did not predict clinical progression or the need for neurosurgical intervention. However, higher Biffl grades and intracranial hemorrhage among patients with BCVI were associated with a greater risk of clinical progression or the need for neurosurgical intervention. These findings support the integration of BCVI-specific factors into triage models and highlight the need for refined clinical pathways that supplement BIG classification when BCVI is present.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.8.jns251350","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:16Z","timestamp":1769083216000},"page":"1477-1486","source":"Crossref","is-referenced-by-count":3,"title":["Clinical progression in patients with concomitant blunt cerebrovascular injury and traumatic brain injury classified using the Brain Injury Guidelines"],"prefix":"10.3171","volume":"144","author":[{"given":"Samuel A.","family":"Tenhoeve","sequence":"first","affiliation":[{"name":"Spencer Fox Eccles School of Medicine, University of Utah;"},{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Brown","sequence":"additional","affiliation":[{"name":"Spencer Fox Eccles School of Medicine, University of Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew C.","family":"Findlay","sequence":"additional","affiliation":[{"name":"Spencer Fox Eccles School of Medicine, University of Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saachi","family":"Jhandi","sequence":"additional","affiliation":[{"name":"Spencer Fox Eccles School of Medicine, University of Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Cortez","sequence":"additional","affiliation":[{"name":"University of Utah Health Trauma Program, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Grandhi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Lombardo","sequence":"additional","affiliation":[{"name":"University of Utah Health Trauma Program, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toby","family":"Enniss","sequence":"additional","affiliation":[{"name":"University of Utah Health Trauma Program, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah T.","family":"Menacho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"J Trauma Acute Care Surg","first-page":"157","article-title":"Validating the Brain Injury Guidelines: results of an American Association for the Surgery of Trauma prospective multi-institutional trial","volume":"93","author":"Joseph B","year":"2022","unstructured":"Joseph B, Obaid O, Dultz L, Validating the Brain Injury Guidelines: results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022;93(2):157\u2013165."},{"key":"b2","series-title":"NICE Guideline Head Injury. Evidence Reviews for Isolated Skull Fracture. NICE Guideline NG232","article-title":"National Institute for Health and Care Excellence (NICE)","year":"2023","unstructured":"NICE Guideline Head Injury. Evidence Reviews for Isolated Skull Fracture. NICE Guideline NG232. National Institute for Health and Care Excellence (NICE); 2023. Accessed September 15, 2025. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK592432\/"},{"issue":"3","key":"b3","series-title":"J Neurosurg","first-page":"782","article-title":"External validation of the updated Brain Injury Guidelines for complicated mild traumatic brain injuries: a retrospective cohort study","volume":"137","author":"Tourigny JN","year":"2022","unstructured":"Tourigny JN, Boucher V, Paquet V, External validation of the updated Brain Injury Guidelines for complicated mild traumatic brain injuries: a retrospective cohort study. J Neurosurg. 2022;137(3):782\u2013788."},{"key":"b4","series-title":"Am J Emerg Med","first-page":"127","article-title":"Identification and management of low-risk isolated traumatic brain injury patients initially treated at a rural level IV trauma center","volume":"78","author":"Nene RV","year":"2024","unstructured":"Nene RV, Corbett B, Lambert G, Identification and management of low-risk isolated traumatic brain injury patients initially treated at a rural level IV trauma center. Am J Emerg Med. 2024;78:127\u2013131."},{"issue":"6","key":"b5","series-title":"J Trauma Acute Care Surg","first-page":"944","article-title":"Reducing low-value interhospital transfers for mild traumatic brain injury","volume":"96","author":"Shen A","year":"2024","unstructured":"Shen A, Mizraki N, Maya M, Reducing low-value interhospital transfers for mild traumatic brain injury. J Trauma Acute Care Surg. 2024;96(6):944\u2013948."},{"issue":"7","key":"b6","series-title":"Arch Surg","first-page":"685","article-title":"Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents","volume":"144","author":"Cothren CC","year":"2009","unstructured":"Cothren CC, Biffl WL, Moore EE, Kashuk JL, Johnson JL. Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents. Arch Surg. 2009;144(7):685\u2013690."},{"issue":"1","key":"b7","series-title":"J Neurosurg","first-page":"16","article-title":"Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution","volume":"127","author":"Esnault P","year":"2017","unstructured":"Esnault P, Cardinale M, Boret H, Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution. J Neurosurg. 2017;127(1):16\u201322."},{"issue":"5","key":"b8","series-title":"J Trauma Acute Care Surg","first-page":"858","article-title":"Time to stroke: a Western Trauma Association multicenter study of blunt cerebrovascular injuries","volume":"85","author":"Burlew CC","year":"2018","unstructured":"Burlew CC, Sumislawski JJ, Behnfield CD, Time to stroke: a Western Trauma Association multicenter study of blunt cerebrovascular injuries. J Trauma Acute Care Surg. 2018;85(5):858\u2013866."},{"issue":"6","key":"b9","series-title":"J Trauma Acute Care Surg","first-page":"875","article-title":"Evaluation and management of blunt cerebrovascular injury: a practice management guideline from the Eastern Association for the Surgery of Trauma","volume":"88","author":"Kim DY","year":"2020","unstructured":"Kim DY, Biffl W, Bokhari F, Evaluation and management of blunt cerebrovascular injury: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875\u2013887."},{"issue":"2","key":"b10","series-title":"Neurosurgery","first-page":"340","article-title":"Management patterns and outcomes after traumatic brain injury with associated blunt cerebrovascular injury","volume":"94","author":"Findlay MC","year":"2024","unstructured":"Findlay MC, Sarriera-Valentin G, Earl ER, Management patterns and outcomes after traumatic brain injury with associated blunt cerebrovascular injury. Neurosurgery. 2024;94(2):340\u2013349."},{"issue":"5","key":"b11","series-title":"J Trauma","first-page":"845","article-title":"Blunt carotid arterial injuries: implications of a new grading scale","volume":"47","author":"Biffl WL","year":"1999","unstructured":"Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 1999;47(5):845\u2013853."},{"key":"b12","series-title":"Clin Neurol Neurosurg","first-page":"108704","article-title":"Applying an updated brain injury guideline classification to interhospital transfer of patients with traumatic brain injury: who benefits most?","volume":"249","author":"Tenhoeve SA","year":"2025","unstructured":"Tenhoeve SA, Cole KL, Jhandi S, Applying an updated brain injury guideline classification to interhospital transfer of patients with traumatic brain injury: who benefits most? Clin Neurol Neurosurg. 2025;249:108704."},{"issue":"sup2","key":"b13","series-title":"Traffic Inj Prev","first-page":"S109","article-title":"Evolution of the Abbreviated Injury Scale: 1990\u20132015","volume":"19","author":"Loftis KL","year":"2018","unstructured":"Loftis KL, Price J, Gillich PJ. Evolution of the Abbreviated Injury Scale: 1990\u20132015. Traffic Inj Prev. 2018;19(sup2):S109\u2013S113."},{"issue":"2","key":"b14","series-title":"J Neurosurg","first-page":"461","article-title":"Transition from classic to expanded Denver screening criteria for blunt cerebrovascular injury: lessons from a high-volume level I trauma center","volume":"143","author":"Casado-Ruiz J","year":"2025","unstructured":"Casado-Ruiz J, Casta\u00f1o-Leon AM, Garc\u00eda-Escudero L, Huerta-Carrascosa M, Vidal-Terrancle M, Lagares A. Transition from classic to expanded Denver screening criteria for blunt cerebrovascular injury: lessons from a high-volume level I trauma center. J Neurosurg. 2025;143(2):461\u2013471."},{"issue":"1","key":"b15","series-title":"J Neurosurg","first-page":"109","article-title":"Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury","volume":"96","author":"Oertel M","year":"2002","unstructured":"Oertel M, Kelly DF, McArthur D, Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 2002;96(1):109\u2013116."},{"issue":"12","key":"b16","series-title":"Injury","first-page":"2122","article-title":"The temporal course of intracranial haemorrhage progression: how long is observation necessary?","volume":"43","author":"Homnick A","year":"2012","unstructured":"Homnick A, Sifri Z, Yonclas P, Mohr A, Livingston D. The temporal course of intracranial haemorrhage progression: how long is observation necessary? Injury. 2012;43(12):2122\u20132125."},{"issue":"5","key":"b17","series-title":"Ann Surg","first-page":"699","article-title":"Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography","volume":"235","author":"Biffl WL","year":"2002","unstructured":"Biffl WL, Ray CE, Moore EE, Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg. 2002;235(5):699\u2013706."},{"issue":"6","key":"b18","series-title":"J Trauma Acute Care Surg","first-page":"1063","article-title":"Long-term follow-up of blunt cerebrovascular injuries: does time heal all wounds?","volume":"81","author":"Laser A","year":"2016","unstructured":"Laser A, Bruns BR, Kufera JA, Long-term follow-up of blunt cerebrovascular injuries: does time heal all wounds? J Trauma Acute Care Surg. 2016;81(6):1063\u20131069."},{"issue":"3","key":"b19","series-title":"J Vasc Surg","first-page":"685","article-title":"The role of number of affected vessels on radiologic and clinical outcomes of patients with blunt cerebrovascular injury","volume":"80","author":"Hosseinpour H","year":"2024","unstructured":"Hosseinpour H, Magnotti LJ, Huang DD, The role of number of affected vessels on radiologic and clinical outcomes of patients with blunt cerebrovascular injury. J Vasc Surg. 2024;80(3):685\u2013692."},{"issue":"2","key":"b1","series-title":"J Trauma Acute Care Surg","first-page":"157","article-title":"Validating the Brain Injury Guidelines: results of an American Association for the Surgery of Trauma prospective multi-institutional trial","volume":"93","author":"Joseph B","year":"2022","unstructured":"Joseph B, Obaid O, Dultz L, Validating the Brain Injury Guidelines: results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022;93(2):157\u2013165."},{"key":"b2","series-title":"NICE Guideline Head Injury. Evidence Reviews for Isolated Skull Fracture. NICE Guideline NG232","article-title":"National Institute for Health and Care Excellence (NICE)","year":"2023","unstructured":"NICE Guideline Head Injury. Evidence Reviews for Isolated Skull Fracture. NICE Guideline NG232. National Institute for Health and Care Excellence (NICE); 2023. Accessed September 15, 2025. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK592432\/"},{"issue":"3","key":"b3","series-title":"J Neurosurg","first-page":"782","article-title":"External validation of the updated Brain Injury Guidelines for complicated mild traumatic brain injuries: a retrospective cohort study","volume":"137","author":"Tourigny JN","year":"2022","unstructured":"Tourigny JN, Boucher V, Paquet V, External validation of the updated Brain Injury Guidelines for complicated mild traumatic brain injuries: a retrospective cohort study. J Neurosurg. 2022;137(3):782\u2013788."},{"key":"b4","series-title":"Am J Emerg Med","first-page":"127","article-title":"Identification and management of low-risk isolated traumatic brain injury patients initially treated at a rural level IV trauma center","volume":"78","author":"Nene RV","year":"2024","unstructured":"Nene RV, Corbett B, Lambert G, Identification and management of low-risk isolated traumatic brain injury patients initially treated at a rural level IV trauma center. Am J Emerg Med. 2024;78:127\u2013131."},{"issue":"6","key":"b5","series-title":"J Trauma Acute Care Surg","first-page":"944","article-title":"Reducing low-value interhospital transfers for mild traumatic brain injury","volume":"96","author":"Shen A","year":"2024","unstructured":"Shen A, Mizraki N, Maya M, Reducing low-value interhospital transfers for mild traumatic brain injury. J Trauma Acute Care Surg. 2024;96(6):944\u2013948."},{"issue":"7","key":"b6","series-title":"Arch Surg","first-page":"685","article-title":"Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents","volume":"144","author":"Cothren CC","year":"2009","unstructured":"Cothren CC, Biffl WL, Moore EE, Kashuk JL, Johnson JL. Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents. Arch Surg. 2009;144(7):685\u2013690."},{"issue":"1","key":"b7","series-title":"J Neurosurg","first-page":"16","article-title":"Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution","volume":"127","author":"Esnault P","year":"2017","unstructured":"Esnault P, Cardinale M, Boret H, Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution. J Neurosurg. 2017;127(1):16\u201322."},{"issue":"5","key":"b8","series-title":"J Trauma Acute Care Surg","first-page":"858","article-title":"Time to stroke: a Western Trauma Association multicenter study of blunt cerebrovascular injuries","volume":"85","author":"Burlew CC","year":"2018","unstructured":"Burlew CC, Sumislawski JJ, Behnfield CD, Time to stroke: a Western Trauma Association multicenter study of blunt cerebrovascular injuries. J Trauma Acute Care Surg. 2018;85(5):858\u2013866."},{"issue":"6","key":"b9","series-title":"J Trauma Acute Care Surg","first-page":"875","article-title":"Evaluation and management of blunt cerebrovascular injury: a practice management guideline from the Eastern Association for the Surgery of Trauma","volume":"88","author":"Kim DY","year":"2020","unstructured":"Kim DY, Biffl W, Bokhari F, Evaluation and management of blunt cerebrovascular injury: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875\u2013887."},{"issue":"2","key":"b10","series-title":"Neurosurgery","first-page":"340","article-title":"Management patterns and outcomes after traumatic brain injury with associated blunt cerebrovascular injury","volume":"94","author":"Findlay MC","year":"2024","unstructured":"Findlay MC, Sarriera-Valentin G, Earl ER, Management patterns and outcomes after traumatic brain injury with associated blunt cerebrovascular injury. Neurosurgery. 2024;94(2):340\u2013349."},{"issue":"5","key":"b11","series-title":"J Trauma","first-page":"845","article-title":"Blunt carotid arterial injuries: implications of a new grading scale","volume":"47","author":"Biffl WL","year":"1999","unstructured":"Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 1999;47(5):845\u2013853."},{"key":"b12","series-title":"Clin Neurol Neurosurg","first-page":"108704","article-title":"Applying an updated brain injury guideline classification to interhospital transfer of patients with traumatic brain injury: who benefits most?","volume":"249","author":"Tenhoeve SA","year":"2025","unstructured":"Tenhoeve SA, Cole KL, Jhandi S, Applying an updated brain injury guideline classification to interhospital transfer of patients with traumatic brain injury: who benefits most? Clin Neurol Neurosurg. 2025;249:108704."},{"issue":"sup2","key":"b13","series-title":"Traffic Inj Prev","first-page":"S109","article-title":"Evolution of the Abbreviated Injury Scale: 1990\u20132015","volume":"19","author":"Loftis KL","year":"2018","unstructured":"Loftis KL, Price J, Gillich PJ. Evolution of the Abbreviated Injury Scale: 1990\u20132015. Traffic Inj Prev. 2018;19(sup2):S109\u2013S113."},{"issue":"2","key":"b14","series-title":"J Neurosurg","first-page":"461","article-title":"Transition from classic to expanded Denver screening criteria for blunt cerebrovascular injury: lessons from a high-volume level I trauma center","volume":"143","author":"Casado-Ruiz J","year":"2025","unstructured":"Casado-Ruiz J, Casta\u00f1o-Leon AM, Garc\u00eda-Escudero L, Huerta-Carrascosa M, Vidal-Terrancle M, Lagares A. Transition from classic to expanded Denver screening criteria for blunt cerebrovascular injury: lessons from a high-volume level I trauma center. J Neurosurg. 2025;143(2):461\u2013471."},{"issue":"1","key":"b15","series-title":"J Neurosurg","first-page":"109","article-title":"Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury","volume":"96","author":"Oertel M","year":"2002","unstructured":"Oertel M, Kelly DF, McArthur D, Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 2002;96(1):109\u2013116."},{"issue":"12","key":"b16","series-title":"Injury","first-page":"2122","article-title":"The temporal course of intracranial haemorrhage progression: how long is observation necessary?","volume":"43","author":"Homnick A","year":"2012","unstructured":"Homnick A, Sifri Z, Yonclas P, Mohr A, Livingston D. The temporal course of intracranial haemorrhage progression: how long is observation necessary? Injury. 2012;43(12):2122\u20132125."},{"issue":"5","key":"b17","series-title":"Ann Surg","first-page":"699","article-title":"Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography","volume":"235","author":"Biffl WL","year":"2002","unstructured":"Biffl WL, Ray CE, Moore EE, Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg. 2002;235(5):699\u2013706."},{"issue":"6","key":"b18","series-title":"J Trauma Acute Care Surg","first-page":"1063","article-title":"Long-term follow-up of blunt cerebrovascular injuries: does time heal all wounds?","volume":"81","author":"Laser A","year":"2016","unstructured":"Laser A, Bruns BR, Kufera JA, Long-term follow-up of blunt cerebrovascular injuries: does time heal all wounds? J Trauma Acute Care Surg. 2016;81(6):1063\u20131069."},{"issue":"3","key":"b19","series-title":"J Vasc Surg","first-page":"685","article-title":"The role of number of affected vessels on radiologic and clinical outcomes of patients with blunt cerebrovascular injury","volume":"80","author":"Hosseinpour H","year":"2024","unstructured":"Hosseinpour H, Magnotti LJ, Huang DD, The role of number of affected vessels on radiologic and clinical outcomes of patients with blunt cerebrovascular injury. J Vasc Surg. 2024;80(3):685\u2013692."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/144\/6\/article-p1477.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/144\/6\/article-p1477.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/144\/6\/article-p1477.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T14:33:00Z","timestamp":1781793180000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/144\/6\/article-p1477.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":38,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2025.8.jns251350","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}