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Universal Screening for Blunt Cerebrovascular Injury (PRaCTUS BCVI)

30. oktober 2026 opdateret af: 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.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

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.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

5000

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Undersøgelse Kontakt Backup

Studiesteder

    • Virginia
      • Falls Church, Virginia, Forenede Stater, 22042
        • Inova Health System
        • Kontakt:
        • Kontakt:
        • Ledende efterforsker:
          • Stefan Leichtle, MD, MBA
        • Underforsker:
          • Stephen Varga, MD

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 99 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

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

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Screening
  • Tildeling: Randomiseret
  • Interventionel model: Crossover opgave
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: 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.

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.

Aktiv komparator: Universal Screening

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

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

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Number of Participants with BCVI-related Ischemic Stroke
Tidsramme: 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

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Incidence of BCVI-Related Stroke per 1000 Major Blunt Trauma Admissions
Tidsramme: 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
Tidsramme: 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)

Andre resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Antithrombotic-related bleeding
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Samarbejdspartnere

Efterforskere

  • Ledende efterforsker: Stefan W Leichtle, MD, MBA, Inova Health Care Services

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

1. november 2026

Primær færdiggørelse (Anslået)

1. november 2027

Studieafslutning (Anslået)

1. december 2027

Datoer for studieregistrering

Først indsendt

30. oktober 2026

Først indsendt, der opfyldte QC-kriterier

30. oktober 2026

Først opslået (Faktiske)

5. november 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

5. november 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

30. oktober 2026

Sidst verificeret

1. oktober 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • INOVA-2026-299

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

IPD-planbeskrivelse

No individual patient data will be shared.

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

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