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Indications for computed tomography angiography in limb trauma
Wasim Awal1,2, Julia De Groot1,2
1Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
Insights
Computed tomography angiograms (CTAs) for limb trauma are indicated by hard signs of vascular compromise or an arterial pressure index (API) <0.9. Soft signs may guide API testing, and CTAs are not routinely needed for knee dislocations.
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.
Introduction:
Computed tomography angiograms (CTAs) are useful in detecting vascular injury. There is a lack of consensus regarding the indications of CTAs in limb trauma, leading to overutilisation of CTAs in some centres and exposing patients to unnecessary harm. Thus, the aim of this study is to define the appropriate indications for CTAs in limb trauma.
Methods:
This is a retrospective cohort study of consecutive CTAs performed in a tertiary hospital from January to December 2022. Demographic and clinical factors were collected from the patients' charts including physical examination findings and arterial pressure index (API) measurements. Physical examination findings include hard signs (e.g. absent pulse) or soft signs (e.g. non-expanding haematoma). These data were analysed to detect correlation with vascular injury on the patient's CTA.
Results:
Forty-nine CTAs were included, of which 10 (20.4%) found vascular injury. Hard signs (P < 0.001) and an API <0.9 (P = 0.02) were significantly correlated with vascular injury. Hard signs had a sensitivity of 90% and specificity of 82%, whereas APIs had a specificity and sensitivity of 100%. Soft signs were not correlated with vascular injury due to poor specificity but had a sensitivity of 100%. Knee dislocations were not associated with vascular injury (P = 0.5).
Conclusion:
This small study suggests that CTAs are indicated if there are hard signs of vascular compromise or an API <0.9, provided the patient is haemodynamically stable. The presence of soft signs can help identify which patients should receive an API measurement. CTAs may not be routinely indicated in knee dislocations.
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