Universal Screening for Blunt Cerebrovascular Injury (PRaCTUS BCVI)

October 30, 2026 updated by: Inova Health Care Services

Pragmatic Randomized Clinical Trial of Universal Screening for BCVI

The goal of this clinical trial is to test whether screening all major blunt trauma patients for blood vessel injuries in the neck and head using CT scans (universal screening) leads to fewer strokes and stroke-related deaths compared to screening only selected patients who meet specific risk criteria (selective screening).

This is a pilot feasibility study. The main questions this study aims to answer are:

Can trauma centers that currently use selective screening successfully switch to universal screening? Are the definitions used to identify and measure outcomes clear and applied consistent across all participating hospitals? Do stroke complications occur frequently enough to support a larger, future clinical trial? Can participating trauma centers reliably track and report the number of CT scans performed for this purpose?

Participating trauma centers in the study will: Continue using their existing selective screening approach at the start of the study Switch to universal CT screening of all major blunt trauma patients at an assigned point during the 12-month study period Submit de-identified patient data to the coordinating center using a secure electronic database Researchers will use the result of this initial feasibility study to determine whether a larger clinical trial comparing the two screening strategies is feasible.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

This study evaluates the feasibility of conducting a clinical trial comparing outcomes for selective screening versus universal screening in adult major blunt trauma patients at level 1 and 2 trauma centers in the United States. The primary outcome is BCVI-related ischemic stroke. The secondary outcome is a composite of BCVI-related stroke or stroke-related death.

The design of this study is a pragmatic stepped-wedge cluster-randomized trial. The choice between SS and US is an institutional policy decision rather than an individual patient decision, the unit of randomization is the Trauma Center (TC). Both strategies are widely used at TCs in the United States and considered standard of care. Genuine clinical equipoise exists. The principal risk of US is additional imaging and treatment; the principal risk of SS is a missed injury and a potentially preventable stroke. Neither strategy has been shown to be superior with respect to patient-centered outcomes.

Discussion of the trial and initial findings are expected to facilitate recruitment for the definitive trial, which is anticipated to enroll at least 20 Level 1 and 2 TCs for three or more years.

Study Type

Interventional

Enrollment (Estimated)

5000

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • United States
    • Virginia
      • Falls Church, Virginia, United States, 22042
        • Inova Health System
        • Contact:
        • Contact:
        • Principal Investigator:
          • Stefan Leichtle, MD, MBA
        • Sub-Investigator:
          • Stephen Varga, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 99 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Age 18 or older
  • Major blunt trauma and presented as a trauma activation or consultation at a level 1 or 2 trauma center
  • Patient undergoing whole body trauma CT scan or at least CT cervical spine and/or CTA chest based on the trauma team's concern for major injuries

Exclusion Criteria:

  • Transferred patients
  • Prisoners
  • Age less than 18

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Screening
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Selective Screening

Participating institution assigned to perform select screening for adult major blunt trauma patients with CTA of the neck based on Denver, Expanded Denver, Memphis, or ACS Best Practices criteria. Participating centers will continue with the screening method currently in place prior so study participation.
Procedure: Selective Screening

Screening select adult major blunt trauma patients with CTA of the neck based on Denver, Expanded Denver, Memphis, or ACS Best Practices criteria. Participating centers will continue with the screening method currently in place prior so study participation.
Active Comparator: Universal Screening

Participating institution assigned to perform universal screening all adult major blunt trauma patients with CTA of the neck.
Procedure: Universal Screening

Screening all adult major blunt trauma patients with CTA of the neck.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of Participants with BCVI-related Ischemic Stroke
Time Frame: In-hospital, from admission to discharge or in-hospital death; aggregated over the 12-month data-collection period by screening condition

BCVI-related ischemic stroke is defined as any ischemic stroke occurring during the hospital stay in a vascular territory suggestive of cervical arterial injury, or any ischemic stroke occurring during the hospital stay in a patient with confirmed BCVI (or before discharge or patient death). Strokes present on admission imaging will be recorded but analyzed separately and not classified as BCVI-related.
In-hospital, from admission to discharge or in-hospital death; aggregated over the 12-month data-collection period by screening condition

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of BCVI-Related Stroke per 1000 Major Blunt Trauma Admissions
Time Frame: From hospital admission until hospital discharge or in-hospital death, whichever occurs first (up to 14 days)

Incidence of BCVI-related stroke, measured at the population level as events per 1,000 major blunt trauma admissions and compared between screening conditions. BCVI-related stroke is any in-hospital ischemic stroke in a vascular territory suggestive of cervical arterial injury or in a patient with confirmed BCVI; hemorrhagic strokes and strokes on admission imaging are excluded.
From hospital admission until hospital discharge or in-hospital death, whichever occurs first (up to 14 days)
Incidence of Stroke-Related Mortality per 1,000 Major Blunt Trauma Admissions
Time Frame: From hospital admission until hospital discharge or in-hospital death, whichever occurs first (up to 14 days)

Incidence of stroke-related death, measured at the population level as events per 1,000 major blunt trauma admissions and compared between screening conditions. Stroke-related death is any in-hospital death deemed by the treatment team to result primarily from a BCVI-related stroke.
From hospital admission until hospital discharge or in-hospital death, whichever occurs first (up to 14 days)

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Antithrombotic-related bleeding
Time Frame: During the hospitalization for the traumatic event, up to 14 days

Incidence of antithrombotic-related bleeding events
During the hospitalization for the traumatic event, up to 14 days
BCVI detection rate
Time Frame: In-hospital, from admission to discharge or in-hospital death; aggregated over the 12-month data-collection period by screening condition

Rate of BCVI diagnoses per 1000 patients screened
In-hospital, from admission to discharge or in-hospital death; aggregated over the 12-month data-collection period by screening condition
CTA utilization
Time Frame: In-hospital, from admission to discharge or in-hospital death; aggregated over the 12-month data-collection period by screening condition

CTAs performed per 1000 major blunt trauma admissions per institution
In-hospital, from admission to discharge or in-hospital death; aggregated over the 12-month data-collection period by screening condition

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Inova Health Care Services

Collaborators

American Association for the Surgery of Trauma

Investigators

  • Principal Investigator: Stefan W Leichtle, MD, MBA, Inova Health Care Services

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

November 1, 2026

Primary Completion (Estimated)

November 1, 2027

Study Completion (Estimated)

December 1, 2027

Study Registration Dates

First Submitted

October 30, 2026

First Submitted That Met QC Criteria

October 30, 2026

First Posted (Actual)

November 5, 2026

Study Record Updates

Last Update Posted (Actual)

November 5, 2026

Last Update Submitted That Met QC Criteria

October 30, 2026

Last Verified

October 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • INOVA-2026-299

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

No individual patient data will be shared.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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