title: Predicting arterial injuries after penetrating brain trauma based on scoring signs from emergency CT studies.
abstract: The objective of this study was to determine the accuracy of individual radiologists in detection of vascular injury in patients after penetrating brain injury (PBI) based on head CT findings at admission. We retrospectively evaluated 54 PBI patients who underwent admission head CT and digital subtraction angiography (DSA), used here as a reference standard. Two readers reviewed the CT images to determine the presence or absence of the 29 CT variables of injury profile and quantified selected variables. Four experienced trauma radiologists and one neuroradiologist assigned their own specific scores for each CT variable, a high score indicative of a high probability of artery injury. A sixth set consisted of the average score obtained from the five sets, generated by five experts. Receiver operating characteristic (ROC) curves were constructed for each set to assess the diagnostic performance of an individual radiologist in predicting an underlying vascular injury. The area under ROC curve (AUC) was higher for CT scores obtained from the sixth set (average of five sets of scores) of variable rank score 0.75 (95% CI 0.62-0.88) and for the rest of the data sets, the value ranged from 0.70 (95% CI 0.56-0.84) to 0.74 (95% CI 0.6-0.88). In conclusion, radiologists may be able to recommend DSA with a fair accuracy rate in selected patients, deemed 'high-risk' for developing intracranial vascular injuries after PBI based on admission CT studies. A better approach needs to be developed to reduce the false positive rate to avoid unnecessary emergency DSA.
authors.affiliation: Department of Radiology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center; Baltimore, Maryland, USA - ubodanapally@umm.edu.
authors.forename: Uttam K
authors.initials: UK
authors.lastname: Bodanapally
authors.affiliation: Department of Radiology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center; Baltimore, Maryland, USA.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Krejza
authors.affiliation: Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University; Bangkok, Thailand.
authors.forename: Nitima
authors.initials: N
authors.lastname: Saksobhavivat
authors.affiliation: Department of Radiology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center; Baltimore, Maryland, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Jaffray
authors.affiliation: Department of Radiology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center; Baltimore, Maryland, USA.
authors.forename: Clint W
authors.initials: CW
authors.lastname: Sliker
authors.affiliation: Department of Radiology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center; Baltimore, Maryland, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Miller
authors.affiliation: Department of Radiology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center; Baltimore, Maryland, USA.
authors.forename: Kathirkamanathan
authors.initials: K
authors.lastname: Shanmuganathan
authors.affiliation: Department of Radiology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center; Baltimore, Maryland, USA.
authors.forename: David
authors.initials: D
authors.lastname: Dreizin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods / Q000592:standards; D002533:Cerebral Angiography / Q000379:methods / Q000592:standards; D002536:Cerebral Arteries / Q000293:injuries*; D005260:Female; D020197:Head Injuries, Penetrating / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009485:Neuroradiography / Q000379:methods / Q000592:standards; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards*; D015599:Trauma Severity Indices; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging; D055815:Young Adult
keywords: civilian penetrating traumatic brain injury; digital subtraction angiography; gunshot injuries to head; intracranial arterial injuries; traumatic intracranial pseudo-aneurysms
references.citation: Neurosurgery. 1991 Jan;28(1):1-7
references.pmid: 1994264
references.citation: Stroke. 1990 Aug;21(8):1156-61
references.pmid: 2389295
references.citation: Neuroradiol J. 2012 Sep;25(4):469-74
references.pmid: 24029039
references.citation: Neuroradiol J. 2011 Oct 31;24(5):715-25
references.pmid: 24059766
references.citation: Neuroradiol J. 2012 Nov;25(5):563-8
references.pmid: 24029091
references.citation: Radiology. 1982 Apr;143(1):91-6
references.pmid: 6977795
references.citation: AJR Am J Roentgenol. 2008 Mar;190(3):790-9
references.pmid: 18287454
references.citation: J Trauma. 2001 Aug;51(2 Suppl):S26-8
references.pmid: 11505196
references.citation: J Neurosurg. 1996 May;84(5):769-80
references.pmid: 8622150
references.citation: Neurosurgery. 1988 Jun;22(6 Pt 1):1056-63
references.pmid: 3419568
references.citation: AJR Am J Roentgenol. 1992 Aug;159(2):365-8
references.pmid: 1632358
references.citation: Neurosurgery. 2010 Jan;66(1):66-79; discussion 79
references.pmid: 20023539
references.citation: Neurosurg Clin N Am. 1995 Oct;6(4):775-97
references.pmid: 8527918
references.citation: Neurosurgery. 1993 Apr;32(4):532-40
references.pmid: 8474643