Diagnostic performance of CT angiography in neck vessel trauma: systematic review and meta-analysis

This study was conducted in order to define the diagnostic performance of CT angiography for vascular injuries compared with angiography in patients with neck trauma. CT angiography is the cornerstone of diagnosis for hemodynamically stable patients with wounds suspicious of vascular trauma in the limbs, chest, or abdomen. Available evidence for the use of CT angiography in neck vascular trauma comes from small case series and few randomized controlled trials, and high-quality information does not exist regarding its performance. A protocol using the recommendations of the Cochrane Collaboration was designed. A systematic search of diagnostic studies without limits on language or time was carried out to December 2014. Studies including patients with neck trauma with retrospective or prospective data collection that assessed CT angiography compared with other methods were selected. Methodological quality was assessed using the QUADAS-2 tool. A hierarchical model ROC curve and a bivariate random effects model were used for the pooled analysis. Sixteen studies were selected and reviewed, and nine studies with 693 patients were included in this review. The overall sensitivity was 97 % (95 % CI 0.77-1.00; I (2) = 65.7 % (41.4-90.0)), while the overall specificity was 99 % (95 % CI 0.93-1.00; I (2) = 0). The hierarchic ROC curve showed an area under the curve of 0.99. Publication bias was not identified in this study. CT angiography can be stated as the gold standard for diagnosing vascular injuries in hemodynamically stable patients with neck trauma.