title: Utility of screening for blunt vascular neck injuries with computed tomographic angiography.
abstract: OBJECTIVE
  To prospectively study the impact of implementing a computed tomographic angiography (CTA)-based screening protocol on the detected incidence and associated morbidity and mortality of blunt vascular neck injury (BVNI).
  
  
  METHODS
  Consecutive blunt trauma patients admitted to a single tertiary trauma center and identified as at risk for BVNI underwent admission CTA using an eight-slice multi-detector computed tomography scanner. The detected incidence, morbidity, and mortality rates of BVNI were compared with those measured before CTA screening. A logistic regression model was also applied to further evaluate potential risk factors for BVNI.
  
  
  RESULTS
  A total of 1,313 blunt trauma patients were evaluated. One hundred seventy screening CTAs were performed, of which 33 disclosed abnormalities. Twenty-three were evaluated angiographically, of which 15 were considered to have significant BVNIs, as were 4 of the 10 patients with abnormal CTAs and no angiogram. The incidence of angiographically proven BVNIs in our series was 1.1%. If four patients who were treated for BVNIs based on CTA alone are included, the incidence rises to 1.4%. This is significantly higher than the 0.17% incidence before screening (p < 0.001). In addition, the delayed stroke rate and injury-specific mortality fell significantly from 67% to 0% (p < 0.001) and 38% to 0% (p = 0.002), respectively. Overall mortality also fell significantly, from 38% to 10.5% (p = 0.049). Univariate logistic regression identified the presence of cervical spine injury as a significant predictor of BVNI (p < 0.001).
  
  
  CONCLUSIONS
  CTA screening increases the detected incidence of BVNI 8-fold, with rates similar to angiographically based screening protocols. CTA screening significantly decreases BVNI-related morbidity and mortality in an efficient manner, underlying its utility in the early diagnosis of this injury.
authors.affiliation: Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Schneidereit
authors.forename: Richard
authors.initials: R
authors.lastname: Simons
authors.forename: Savvas
authors.initials: S
authors.lastname: Nicolaou
authors.forename: Douglas
authors.initials: D
authors.lastname: Graeb
authors.forename: D Ross
authors.initials: DR
authors.lastname: Brown
authors.forename: Andrew
authors.initials: A
authors.lastname: Kirkpatrick
authors.forename: Gary
authors.initials: G
authors.lastname: Redekop
authors.forename: Elaine C
authors.initials: EC
authors.lastname: McKevitt
authors.forename: Amir
authors.initials: A
authors.lastname: Neyestani
mesh_terms: D000328:Adult; D000792:Angiography; D020212:Carotid Artery Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D011446:Prospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000000981:diagnostic imaging* / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality