Multidetector CT angiography in the evaluation of acute blunt head and neck trauma: a proposed acute craniocervical trauma scoring system.
OBJECTIVE
To determine the diagnostic yield of multidetector computed tomographic (CT) angiography in the evaluation of patients presenting to the emergency department with acute blunt head and neck trauma to assess for arterial injury and to propose a practical scoring system for the identification of patients at highest risk of arterial injury.


METHODS
With institutional review board approval, Health Insurance Portability and Accountability Act compliance, and waived informed consent, a retrospective study was conducted of 830 consecutive patients who presented to the emergency department with acute blunt head and neck trauma over 9 years and were evaluated with multidetector CT angiography. Unenhanced CT scans and CT angiograms were reviewed for the presence of cervical interfacetal subluxations and/or dislocations, fractures, intracranial hemorrhage, and arterial injury. Medical records were reviewed for mechanism of injury (MOI). Multivariate logistic regression analysis was performed to identify independent predictors of an increased risk of arterial injury.


RESULTS
Multidetector CT angiographic results showed injury to 118 arterial structures in 106 (12.8%) patients. Multivariate logistic regression analysis showed that the presence of cervical interfacetal subluxation/dislocations (44.4%; odds ratio [OR], 6.3; P < .0001), fracture lines reaching an arterial structure (22.1%; OR, 4.4; P < .0001), and high-impact MOIs (16.5%; OR, 3.1; P < .0001) were independent predictors of an increased risk of arterial injury and were used to construct a scoring system. Patients with scores of 2 and 3 (21.9% and 52.2%, respectively) were at highest risk of arterial injury.


CONCLUSIONS
The proposed acute craniocervical trauma scoring system could be used as a guide to select blunt trauma patients for multidetector CT angiographic evaluation. Future validation of this scoring system is necessary.
Delgado Almandoz
Josser E
JE
Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Gray 2 Room 273A, 55 Fruit St, Boston, MA 02114, USA. delgadoj@mir.wustl.edu
Schaefer
Pamela W
PW
Kelly
Hillary R
HR
Lev
Michael H
MH
Gonzalez
R Gilberto
RG
Romero
Javier M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002533:Cerebral Angiography / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging*; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
D003287:Contrast Media