Incidence and clinical impact of lower extremity vascular injuries in the setting of whole body computed tomography for
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ORIGINAL ARTICLE
Incidence and clinical impact of lower extremity vascular injuries in the setting of whole body computed tomography for trauma Kendal Weger 1 & Peter Hammer 1 & Todd McKinley 1 & Scott Steenburg 1 Received: 1 July 2020 / Accepted: 20 August 2020 # American Society of Emergency Radiology 2020
Abstract Purpose The aims of this study are to determine the incidence of lower extremity fractures and/or vascular injuries in the setting of whole body computed tomography (WBCT) for trauma and to determine lower extremity injury outcomes in this patient population. Methods This is a retrospective observational study performed at a large urban Level 1 trauma center. Our institutional trauma registry was queried for patients who were evaluated with WBCT and lower extremity CT angiography (CTA) as a part of their initial imaging evaluation over a 43-month period. Patients with lower extremity fractures and/or vascular injuries were identified. Those patients with both lower extremity vascular injury and fracture were then analyzed to determine the physical relationship of the fracture to the vascular injury. Physical exam findings were extracted from the medical record. Interventions and long-term outcomes were determined from the medical record. Results A total of 370 patients met the inclusion criteria, with 98% experiencing blunt trauma. Of these, 290 (78.4%) were positive for lower extremity injury, including 266 (71.9%) with isolated fractures, 2 (0.6%) with isolated vascular injury, and 22 (5.9%) with vascular injury associated with long bone fracture. Of the 22 patients with combined fracture and vascular injury, 8 received vascular intervention and 10 had long-term complications as a result of their injuries. Physical exam findings were insufficient to diagnose 57% of the vascular injuries. Conclusions The inclusion of lower extremity CTA as part of a WBCT imaging exam for trauma allows for the identification of vascular injuries that otherwise may have gone undetected or resulted in delayed diagnosis. Clinically occult lower extremity vascular injuries may be associated with poor outcomes. Keywords Whole body CT . CT angiography . Extremity trauma . Wound healing
Introduction Trauma is a significant source of long-term morbidity and mortality, with more life years lost than cardiovascular disease and cancer combined [1]. While somewhat controversial, there is a mounting evidence that contrast-enhanced whole body computed tomography (WBCT) performed in the early stages of trauma patient evaluation improves survival and outcomes [2–9]. The reduction in mortality can be attributed to multiple benefits of WBCT, but primarily the time saved in diagnosis of injuries and rapid triage to definitive therapy. WBCT has been shown to reduce the amount of time spent
* Kendal Weger [email protected] 1
Indiana University School of Medicine and Indiana University Health, Indianapolis, IN, USA
in the emergency department and reduces additional diagnostic tests [8, 10]. In addition, lower extremity computed tomograph
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