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

The aim of this study was to audit the use of Computerised Tomographic Angiography (CTA) in assessing extremity vascular injuries at our institution and to compare it to international standards. The primary aim was to assess the number of CTAs performed and the indications for doing them. The secondary aim was to look at CTA results and clinical findings and to correlate the two.

This is a retrospective review of all patients aged 13 years and older who had CTA performed for suspected extremity vascular injuries due to blunt trauma or gunshot injuries, who presented from January 2012 to December 2012.

Two hundred and eighty five (285) CTAs were performed in 2012 and 137 met our inclusion criteria. Eleven cases were excluded due to insufficient data, leaving a total of 126 cases suitable for analysis. Eighty three patients (66%) had a normal CTA. The indications for CTA were as follows: decreased pulse in 46 patients (42%), absent pulse in 19 patients (17%), presumed knee dislocation in 18 patients (16%), injuries in the proximity of large vessels in 12 patients (11%), haematoma in 8 patients (7%), bleeding in 5 patients (4%) and an abnormal Doppler in 2 patients (2%). When comparing pulse examination to CTA results, the clinical assessment of pulses had a sensitivity of 74.4%, specificity of 53.7%, positive predictive value (PPV) of 45.7% and a negative predictive value (NPV) of 80%.

Incorrect indications are being used when ordering a CTA in extremity vascular trauma. Clinical examination is suboptimal and not a reliable indicator of vascular injury in our setting, leading to a lower threshold for ordering a CTA.