Computerised Tomographic Angiography (CTA) in extremity trauma - A level one hospital experience

Area of Science:

• Medical Imaging
• Vascular Surgery
• Trauma Care

Background:

• Computerised Tomographic Angiography (CTA) is utilized for diagnosing extremity vascular injuries.
• Auditing CTA usage and indications is crucial for optimizing patient care and resource allocation.
• International standards provide benchmarks for evaluating institutional practices.

Purpose of the Study:

• To audit the utilization of CTA in assessing extremity vascular injuries.
• To compare institutional CTA practices with international standards.
• To evaluate the indications for CTA and correlate findings with clinical assessments.

Main Methods:

• Retrospective review of patients aged 13 and older who underwent CTA for suspected extremity vascular injuries.
• Data collected from January 2012 to December 2012, including blunt trauma and gunshot injuries.
• Analysis of CTA results, clinical findings, and indications for the imaging procedure.

Main Results:

• 126 cases were analyzed after applying inclusion criteria.
• A significant proportion of CTAs (66%) revealed normal findings, suggesting potential overuse.
• Clinical assessment of pulses showed low specificity (53.7%) and PPV (45.7%), indicating unreliability.

Conclusions:

• Current indications for CTA in extremity vascular trauma are frequently inappropriate.
• Clinical examination of pulses is suboptimal and unreliable for diagnosing vascular injury.
• There is a tendency towards a lower threshold for ordering CTAs, potentially due to unreliable clinical assessments.