Utility of screening for blunt vascular neck injuries with computed tomographic angiography

J Trauma. 2006 Jan;60(1):209-15; discussion 215-6. doi: 10.1097/01.ta.0000195651.60080.2c.


Purpose: To prospectively study the impact of implementing a computed tomographic angiography (CTA)-based screening protocol on the detected incidence and associated morbidity and mortality of blunt vascular neck injury (BVNI).

Methods: Consecutive blunt trauma patients admitted to a single tertiary trauma center and identified as at risk for BVNI underwent admission CTA using an eight-slice multi-detector computed tomography scanner. The detected incidence, morbidity, and mortality rates of BVNI were compared with those measured before CTA screening. A logistic regression model was also applied to further evaluate potential risk factors for BVNI.

Results: A total of 1,313 blunt trauma patients were evaluated. One hundred seventy screening CTAs were performed, of which 33 disclosed abnormalities. Twenty-three were evaluated angiographically, of which 15 were considered to have significant BVNIs, as were 4 of the 10 patients with abnormal CTAs and no angiogram. The incidence of angiographically proven BVNIs in our series was 1.1%. If four patients who were treated for BVNIs based on CTA alone are included, the incidence rises to 1.4%. This is significantly higher than the 0.17% incidence before screening (p < 0.001). In addition, the delayed stroke rate and injury-specific mortality fell significantly from 67% to 0% (p < 0.001) and 38% to 0% (p = 0.002), respectively. Overall mortality also fell significantly, from 38% to 10.5% (p = 0.049). Univariate logistic regression identified the presence of cervical spine injury as a significant predictor of BVNI (p < 0.001).

Conclusion: CTA screening increases the detected incidence of BVNI 8-fold, with rates similar to angiographically based screening protocols. CTA screening significantly decreases BVNI-related morbidity and mortality in an efficient manner, underlying its utility in the early diagnosis of this injury.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Angiography
  • Carotid Artery Injuries / complications
  • Carotid Artery Injuries / diagnostic imaging*
  • Carotid Artery Injuries / mortality
  • Clinical Protocols*
  • Female
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Neck Injuries / complications
  • Neck Injuries / diagnostic imaging*
  • Neck Injuries / mortality
  • Prospective Studies
  • Risk Assessment
  • Stroke / etiology
  • Stroke / prevention & control
  • Tomography, X-Ray Computed
  • Vertebral Artery / diagnostic imaging*
  • Vertebral Artery / injuries*
  • Wounds, Nonpenetrating / complications
  • Wounds, Nonpenetrating / diagnostic imaging*
  • Wounds, Nonpenetrating / mortality