Table 2.

Overview of clinical recommendations, strength, level of evidence and scientific rationale

Clinical question	Recommendation	Strength of recommendation	Level of evidence	Rationale (Benefits and harms)
What part of the trauma population should be screened for BCVI?	Apply expanded Denver screening criteria	Strong	Low	A documented screening tool ensures focus on the condition. Possible danger of overtriage and unnecessary use of imaging.
Which radiological method should be applied for screening?	CTA has acceptable specificity and sensitivity. DSA remains gold standard	Strong	Moderate	DSA is time consuming, invasive with potential complications and often not available 24–7. CTA is fast and available with lower complication risk. CTA has higher radiation exposure with a risk of false positive findings.
How should BCVI be treated?	Early treatment with either LMWH or AP medication	Strong	Low	Uncertainty of treatment effect. Studies show that early treatment is safe. Risk is worsening of existing hemorrhage.
	Continue treatment with LMWH or AP for at least 3 months	Strong	Low	Long term AP treatment is generally safe, but may cause side effects such as peptic ulcer.
	Pseudoaneurysm or high-grade vessel injury may be considered for endovascular treatment	Conditional	Low	May prevent new or recurrent stroke, but uncertainty of treatment effect or stent patency. Double platelet-inhibitors increases risk of hemorrhage in trauma patients.
How should patients with BCVI be handled over time?	Perform re-imaging at 7 days and 3 months.	Conditional	Low	Repeat imaging can confirm or discard the diagnosis of BCVI. Risk is radiation exposure.

BCVI blunt cerebrovascular injury, CTA CT angiography, DSA digital subtraction angiography, LMWH low molecular weight heparin, AP anti-platelet