(1711) Cost Analysis of Universal BCVI Screening Versus Extended Denver Criteria at a Level 1 Trauma Center

Introduction: Our objective was to report the rates of BCVI and ischemic stroke identified using the extended Denver criteria screening protocol at a level one trauma center and identify any missed injuries using this protocol.

Perform a cost analysis of utilizing universal screening protocol compared to selective screening utilizing the extended Denver Criteria.

Methods: A retrospective review was performed using a community level 1 trauma center registry. All blunt trauma patients in 2023 were included. Rates of screening, injuries, and ischemic strokes were noted. Statistics were performed in Microsoft Excel. A student’s t test was used to compare ISS, LOS, and ICU LOS between screened patients with and without BCVI. Mortality rates were compared using a Chi Squared Analysis. Published hospital self-pay pricing for CTA neck ($3,137) was used for the cost analysis.

Results: A total of 2142 blunt trauma patients were evaluated by the trauma service in 2023. 274 of these 2142 (12.8%) were screened using the extended Denver Criteria. Of these 2142 patients 1.4% had a BCVI. 14 blunt trauma patients had a stroke during their admission and of these, 2 had BCVIs on presentation. Both patients were screened for BVCI on presentation. No patients developed strokes secondary to a BVCI that were not screened for BVCI according to extended Denver criteria.

The ISS for screened patients with a BCVI was significantly higher than those without (21.8 vs. 16.3, p= 0.03). The length of stay and ICU length of stay were both significantly longer as well (6.8 days vs. 10.9 days, p= 0.04 and 6.9 vs. 12.0 days, p= 0.05). There was a trend towards a higher mortality in patients with BCVI (16.1% vs. 7.4%, p=0.09).

The cost of screening every trauma patient that came through our service with a CTA of the neck would have been $ 6,719,454. The cost of screening only patients identified as high risk based on the extended Denver criteria was $859,538.

Conclusions: All BCVIs associated with ischemic strokes were identified on admission with our current screening protocol. Universal screening would not have prevented any strokes at our institution.

The cost of selective screening of patients saved $5,859,916 in radiology fees, when compared to universal screening.