Utility of screening for blunt vascular neck injuries with computed tomographic angiography.
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.
Schneidereit
Nathan P
NP
Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Simons
Richard
R
Nicolaou
Savvas
S
Graeb
Douglas
D
Brown
D Ross
DR
Kirkpatrick
Andrew
A
Redekop
Gary
G
McKevitt
Elaine C
EC
Neyestani
Amir
A
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