Computed Tomography Angiography Utilization in Lower Extremity Trauma: Insights From a Canadian Level I Trauma Centre

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Radiology

Background:

• Computed tomography angiography (CTA) is crucial for diagnosing lower extremity traumatic vascular injuries.
• Overutilization of CTA can lead to increased healthcare costs and longer Emergency Department wait times.
• Optimizing CTA use is essential in trauma care.

Purpose of the Study:

• To evaluate CTA utilization for lower extremity vascular injury in a Canadian Level I trauma center.
• To determine the rate of positive CTA studies that necessitate intervention.
• To identify factors influencing unnecessary CTA examinations.

Main Methods:

• Retrospective analysis of trauma patients undergoing lower extremity CTA (January 2020 - September 2024).
• Data collected included demographics, injury mechanism, physical exam findings, CTA results, ankle-brachial index, and interventions.
• Statistical analysis involved descriptive statistics and chi-square/Fisher's exact tests.

Main Results:

• 612 patients included; 46% had a normal physical exam.
• 27% of CTA studies were positive; 8% of patients required intervention.
• Hard signs of vascular injury correlated significantly with positive CTA and major injuries (P < .001).
• No patients with a normal physical exam and positive CTA required intervention.

Conclusions:

• Nearly half of lower extremity CTA studies were performed on patients with normal physical exams, none of whom required intervention.
• Implementing institution-specific appropriate use criteria could reduce unnecessary CTA studies.
• Clinical assessment, particularly the presence of hard vascular signs, should guide CTA utilization.