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

Introduction: Computed tomography angiography (CTA) plays an important role in assessing patients with suspected lower extremity traumatic vascular injury. However, CTA overutilization has been reported in some centres, and improper use has been linked to increased healthcare costs and prolonged Emergency Department wait times. This study evaluated CTA utilization in a Canadian Level I trauma centre, determined the rate of positive CTA studies requiring intervention, and identified factors that may reduce unnecessary examinations. Methods and Materials: This retrospective study included trauma patients who underwent lower extremity CTA between January 2020 and September 2024. Data regarding patient demographics, mechanism of injury, physical exam and computed tomography findings, ankle-brachial index value, and interventions were collected and evaluated. Statistical analysis included descriptive statistics and chi-square or Fisher's exact tests for categorical associations. Results: Six hundred twelve patients (82% male, median age 32 years) were included. Forty-six percent had a normal physical exam, and CTA was positive in 27% of cases. Eight percent of patients required an intervention, all of whom had at least one hard sign of vascular injury. A statistically significant association was identified between hard signs of a vascular injury and positive CTA findings (P < .001) and major vascular injuries (P < .01). No patients with a normal physical exam and a positive CTA required intervention. Conclusion: Nearly half of the CTA studies were performed on patients with a normal physical exam, none requiring intervention. Our findings suggest that implementing institution-specific appropriate criteria may reduce unnecessary CTA studies.