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

Anthony C. Wang, Michael A. Charters, Jayesh P. Thawani, Khoi Than, Stephen E. Sullivan, Gregory P. Graziano

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1599-1608
Number of pages10
JournalJournal of Trauma and Acute Care Surgery
Volume72
Issue number6
DOIs
StatePublished - Jun 2012
Externally publishedYes

Fingerprint

Nonpenetrating Wounds
Angiography
Digital Subtraction Angiography
Magnetic Resonance Angiography
Cost-Benefit Analysis
Cerebrovascular Trauma
Wounds and Injuries
Costs and Cost Analysis
Basilar Artery
Cost Savings
Computed Tomography Angiography
Spinal Cord Injuries
Medical Records
Neck
Stroke
Incidence

Keywords

  • Blunt cerebrovascular injury
  • Computed tomographic angiography
  • Cost-effectiveness analysis
  • Magnetic resonance angiography
  • Noninvasive imaging

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury. / Wang, Anthony C.; Charters, Michael A.; Thawani, Jayesh P.; Than, Khoi; Sullivan, Stephen E.; Graziano, Gregory P.

In: Journal of Trauma and Acute Care Surgery, Vol. 72, No. 6, 06.2012, p. 1599-1608.

Research output: Contribution to journalArticle

Wang, Anthony C. ; Charters, Michael A. ; Thawani, Jayesh P. ; Than, Khoi ; Sullivan, Stephen E. ; Graziano, Gregory P. / Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 72, No. 6. pp. 1599-1608.
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T1 - Evaluating the use and utility of noninvasive angiography in diagnosing traumatic blunt cerebrovascular injury

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AU - Charters, Michael A.

AU - Thawani, Jayesh P.

AU - Than, Khoi

AU - Sullivan, Stephen E.

AU - Graziano, Gregory P.

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N2 - 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.

AB - 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.

KW - Blunt cerebrovascular injury

KW - Computed tomographic angiography

KW - Cost-effectiveness analysis

KW - Magnetic resonance angiography

KW - Noninvasive imaging

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