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Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury.

Publication ,  Journal Article
Wang, AC; Charters, MA; Thawani, JP; Than, KD; Sullivan, SE; Graziano, GP
Published in: J Trauma Acute Care Surg
June 2012

BACKGROUND: Digital subtraction angiography (DSA) is the gold standard for radiographic diagnosis of blunt cerebrovascular injury (BCVI), but use of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) has increased dramatically in BCVI screening. This study explores the utility, effectiveness, and cost of noninvasive CTA and MRA screening for BCVI. METHODS: Medical records of 2,025 consecutive adults evaluated for acute blunt neck trauma and BCVI were reviewed retrospectively. The incidence of BCVI, level(s) of cervical injury, involvement of foramina transversaria and internal carotid canals, presence of bony dislocation or subluxation, and subsequent treatment received were assessed. Asymptomatic patients were analyzed based on fracture and injury patterns. The cost effectiveness of CTA compared with DSA and the effects of CTA sensitivity and screening yield were determined. RESULTS: Of reviewed patients, 196 received CTA or MRA. Thirty-eight patients (19.4%) were diagnosed with BCVI. Screening yield in patients symptomatic at presentation was 48.8%. Large-vessel internal carotid, vertebral, anterior spinal, and basilar artery occlusion were associated with a positive screen, as were concurrent stroke and spinal cord injury (p < 0.01). Of patients with injuries found with noninvasive imaging, 50.0% of BCVI involved C1-3 fracture, 34.2% involved subluxation, and 65.8% involved foramina transversaria. In both symptomatic and asymptomatic patients, CTA screening was more cost effective than DSA. CONCLUSION: Noninvasive imaging is a safe, accurate, and cost-effective tool for BCVI screening. Symptomatic presentation was the best predictor of BCVI. Significant cost savings were realized using CTA rather than DSA, with similar effectiveness and patient outcomes. LEVEL OF EVIDENCE: Diagnostic study, level III; economic analysis, level IV.

Duke Scholars

Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

June 2012

Volume

72

Issue

6

Start / End Page

1601 / 1610

Location

United States

Related Subject Headings

  • Wounds, Nonpenetrating
  • Tomography, X-Ray Computed
  • Survival Rate
  • Sensitivity and Specificity
  • Retrospective Studies
  • Registries
  • Middle Aged
  • Male
  • Magnetic Resonance Angiography
  • Injury Severity Score
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wang, A. C., Charters, M. A., Thawani, J. P., Than, K. D., Sullivan, S. E., & Graziano, G. P. (2012). Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury. J Trauma Acute Care Surg, 72(6), 1601–1610. https://doi.org/10.1097/TA.0b013e318246ead4
Wang, Anthony C., Michael A. Charters, Jayesh P. Thawani, Khoi D. Than, Stephen E. Sullivan, and Gregory P. Graziano. “Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury.J Trauma Acute Care Surg 72, no. 6 (June 2012): 1601–10. https://doi.org/10.1097/TA.0b013e318246ead4.
Wang AC, Charters MA, Thawani JP, Than KD, Sullivan SE, Graziano GP. Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury. J Trauma Acute Care Surg. 2012 Jun;72(6):1601–10.
Wang, Anthony C., et al. “Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury.J Trauma Acute Care Surg, vol. 72, no. 6, June 2012, pp. 1601–10. Pubmed, doi:10.1097/TA.0b013e318246ead4.
Wang AC, Charters MA, Thawani JP, Than KD, Sullivan SE, Graziano GP. Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury. J Trauma Acute Care Surg. 2012 Jun;72(6):1601–1610.

Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

June 2012

Volume

72

Issue

6

Start / End Page

1601 / 1610

Location

United States

Related Subject Headings

  • Wounds, Nonpenetrating
  • Tomography, X-Ray Computed
  • Survival Rate
  • Sensitivity and Specificity
  • Retrospective Studies
  • Registries
  • Middle Aged
  • Male
  • Magnetic Resonance Angiography
  • Injury Severity Score