The Biffl Scale was published in 1999[^1] and is used to grade a blunt cerebrovascular injury (BCVI), which is diagnosed by means of CT angiography.
Grading
Biffl Grade | Description |
Grade I | Irregularity or Dissection of the vessel lumen with < 25 % luminal narrowing |
Grade II | Dissection or intramural hematoma with ≥ 25% luminal narrowing, intraluminal thrombus, or an elevated intimal flap |
Grade III | |
Grade IV | Occlusion |
Grade V | Vessel transection with free extravasation of contrast material |
Clinical relevance
The Biffl Scale has prognostic and therapeutic relevance in vascular injuries. The risk of stroke increases with increasing severity of injury to the Arteria carotis interna[^1]:
Biffl Grade | Stroke risk (%) | Mortality (%) |
Grade I | 3 % | 11 % |
Grade II | 11 % | 11 % |
Grade III | 33 % | 11 % |
Grade IV | 44% | 22 % |
Grade V | 100 % | 100 % |