Trauma CT evaluation prior to selective angiography in patients with traumatic injuries: negative predictive power and f
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ORIGINAL ARTICLE
Trauma CT evaluation prior to selective angiography in patients with traumatic injuries: negative predictive power and factors affecting its utility John A. Cieslak III 1,2 & Tarek Jazmati 1,2 & Aesha Patel 1 & Humaira Chaudhry 2 & Abhishek Kumar 1 & Sohail Contractor 1 & Pratik A. Shukla 1 Received: 13 February 2020 / Accepted: 13 April 2020 # American Society of Emergency Radiology 2020
Abstract Purpose To evaluate the predictive power of arterial injury detected on contrast-enhanced CT (trauma CT (tCT)) imaging obtained prior to selective angiography for treatment of patients with traumatic abdominal and pelvic injuries. Materials and methods A retrospective chart review was performed of all patients who underwent angiography after undergoing contrast-enhanced CT imaging for the evaluation/treatment of traumatic injuries to the abdomen and pelvis between March 2014 and September 2018. Data collection included demographics, pertinent history and physical findings, CT and angiography findings, treatment information, and outcomes. Results Eighty-nine (63 males, mean age = 45.8 ± 20.5 years) patients that were found to have 102 traumatic injuries on tCT and subsequently underwent angiography met inclusion criteria for this study. Sixty-four injuries demonstrated evidence of traumatic vascular injury on initial tCT. A negative tCT was able to predict subsequent negative angiography in 83% of cases (negative predictive power = 83%). The ability of tCT to rule out a positive finding on subsequent angiography was also 83% (sensitivity = 83%). The average systolic blood pressure and hemoglobin concentration at the time of tCT were higher in patients who had positive tCT than in patients with negative tCT (p < 0.05 and p < 0.01, respectively). The average time to angiography was greater in patients whom had subsequent negative angiography than the patients who had subsequent positive angiography (p < 0.05). Conclusion Contrast-enhanced CT imaging may be able to help stratify patients who may have subsequent negative angiograms. Hemodynamic factors may affect sensitivity of tCT. Shorter time to angiography may increase the chance of identifying the injury on subsequent angiography. Keywords Traumatic hemorrhage . Trauma computed tomography (tCT) . Extravasation . Hemodynamics . Time to angiography (TTA) . Embolization
Introduction IRB approval: The protocol for this study was reviewed by the institutional review board at our institution. * Pratik A. Shukla [email protected] 1
Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, 185 South Orange Ave. MSB F-560, Newark, NJ 07103, USA
2
Division of Body Imaging, Department of Radiology, Rutgers New Jersey Medical School, 185 South Orange Ave. MSB F-560, Newark, NJ 07103, USA
Computed tomography (CT) evaluation is the study of choice for diagnosis and triage in patients who present after acute trauma, having surpassed conventional radiography of the chest and pelvis and focused assessment
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