Indications for computed tomography angiography in limb trauma

Area of Science:

• Radiology
• Vascular Surgery
• Trauma Surgery

Background:

• Computed tomography angiograms (CTAs) are crucial for diagnosing vascular injury in limb trauma.
• Current guidelines lack consensus on CTA indications, leading to overuse and potential patient harm.
• Defining appropriate CTA indications in limb trauma is essential for optimizing patient care.

Purpose of the Study:

• To establish clear indications for utilizing CTAs in patients with limb trauma.
• To reduce unnecessary CTA utilization and associated risks.
• To correlate clinical findings with CTA-detected vascular injuries.

Main Methods:

• Retrospective cohort study of 49 consecutive CTAs performed between January and December 2022.
• Collected demographic and clinical data, including physical examination findings (hard and soft signs) and arterial pressure index (API).
• Analyzed correlations between clinical factors and CTA-confirmed vascular injuries.

Main Results:

• Vascular injury was detected in 10.2% of CTAs.
• Hard signs (e.g., absent pulse) and API <0.9 were significantly correlated with vascular injury (P < 0.001 and P = 0.02, respectively).
• API measurement showed 100% sensitivity and specificity; hard signs had 90% sensitivity and 82% specificity. Soft signs had 100% sensitivity but poor specificity. Knee dislocations were not associated with vascular injury (P = 0.5).

Conclusions:

• CTAs are indicated for limb trauma in hemodynamically stable patients with hard signs of vascular compromise or an API <0.9.
• Soft signs can help identify patients who would benefit from API measurement.
• Routine CTAs for knee dislocations may not be necessary.