Seatbelt Sign as an Indication for Four-vessel Computed Tomography Angiogram of the Neck to Diagnose Blunt Carotid Artery and Other Cervical Vascular Injuries (original) (raw)
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Therapeutics and Clinical Risk Management, 2018
The aim of this study was to evaluate the true incidence of cervical artery dissections (CeADs) in trauma patients with an Injury Severity Score (ISS) of 16,sincehead−and−neckcomputedtomographyangiogram(CTA)isnotacompulsorycomponentofwhole−bodytraumacomputedtomography(CT)protocols.Patientsandmethods:Atotalof230consecutivetraumapatientswithanISSof16, since head-and-neck computed tomography angiogram (CTA) is not a compulsory component of whole-body trauma computed tomography (CT) protocols. Patients and methods: A total of 230 consecutive trauma patients with an ISS of 16,sincehead−and−neckcomputedtomographyangiogram(CTA)isnotacompulsorycomponentofwhole−bodytraumacomputedtomography(CT)protocols.Patientsandmethods:Atotalof230consecutivetraumapatientswithanISSof16 admitted to our Level I trauma center during a 24-month period were prospectively included. Standardized whole-body CT in a 256-detector row scanner included a head-and-neck CTA. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded and analyzed retrospectively in patients with carotid artery dissection (CAD) and vertebral artery dissection (VAD). Results: Of the 230 patients included, 6.5% had a CeAD, 5.2% had a CAD, and 1.7% had a VAD. One patient had both CAD and VAD. For both, CAD and VAD, mortality is 25%. One death was caused by fatal cerebral ischemia due to high-grade CAD. A total of 41.6% of the patients with traumatic CAD and 25% of the patients with VAD had neurological sequelae. Conclusion: Mandatory head-and-neck CTA yields higher CeAD incidence than reported before. We highly recommend the compulsory inclusion of a head-and-neck CTA to wholebody CT routines for severely injured patients.
CT Angiography of the Carotid Arteries in Trauma to the Neck
European Journal of Vascular and Endovascular Surgery, 2001
Objectives: serious vascular injuries to the neck may be asymptomatic or masked by other life-threatening conditions. Angiography, the "gold standard" vascular imaging modality, is an invasive procedure. Moreover, it is time-consuming and thus may delay a needed vascular intervention. The results of screening angiography are negative in more than 80% of cases. Therefore other less invasive and faster screening tests, such as the Doppler ultrasound and magnetic resonance angiography, have been tested. This retrospective study was done to evaluate the use of CT angiography (CTA) in suspected vascular injuries of the neck.
Trauma, 2015
Introduction Neck abrasion/contusions from seatbelts after motor vehicle collisions may be associated with underlying bony or vascular injury. The decision to order imaging is highly subjective, and the yield is low. To date, there is no objective guidance in the literature regarding which patients need imaging. The aim of this study was to derive a scoring system from physical characteristics of seatbelt contusion photographs, based on emergency physician (EP) decisions to order imaging. Methods A survey of a convenience sample of practicing and academic EPs, given five photographs of a spectrum of seatbelt contusions and a standard brief patient description. Respondents were asked whether and which imaging they would perform for each photo. Respondents rated photos for overall clinical concern for underlying injury and for concern regarding color, size, depth, texture and location on a five-point Likert scale. Logistic regression to assess associations between these five features ...
Journal of Clinical Medicine, 2020
Introduction: Traumatic cervical artery dissections are associated with high mortality and morbidity in severely injured patients. After finding even higher incidences than reported before, we decided to incorporate a dedicated head-and-neck computed tomography angiogram (CT-A) in our imaging routine for patients who have been obviously severely injured or, according to trauma mechanism, are suspected to be severely injured. Materials and Methods: A total of 134 consecutive trauma patients with an ISS ≥ 16 admitted to our level I trauma center during an 18 month period were included. All underwent standardized whole-body CT in a 256-detector row scanner with a dedicated head-and-neck CT-A realized as single-bolus split-scan routine. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded and analyzed in patients with carotid artery dissection (CAD) and vertebral artery dissection (VAD). Results: Of the 134 patients included, 7 patients had at...
Scandinavian Journal of Surgery, 2017
Background and Aims: Computed tomography angiography has become central to the diagnostic algorithm for penetrating neck injury, but despite its widespread use the literature to support this adoption is limited. We reviewed our experience with computed tomography angiography for the identification of vascular trauma in hemodynamically stable patients with penetrating neck injury at a major trauma center in South Africa. Materials and Methods: A prospectively kept trauma registry capturing data in real time was retrospectively reviewed. All patients with penetrating neck injury investigated with computed tomography angiography as the initial vascular investigation during a 47-month period were included. Results: A total of 380 patients were included. Indications for computed tomography angiography were as follows: hard signs (13), soft signs (201), no signs but proximity/zone I or III wounds (141), and undefined signs of vascular injury (25). Of the 380 scans, 7 (1.8%) were indetermi...
CT Angiography in Head and Neck Trauma
Radiology, 2010
We read with great interest the article of Dr Delgado Almandoz and colleagues ( 1 ) in the January 2010 issue of Radiology . Their retrospective study included a large cohort of trauma patients who had undergone both unenhanced cervical spine computed tomography (CT) and neck CT angiography.
Right Carotid Artery Dissection Associated With Safety Belt
2018
DOI: 10.21276/sjams.2018.6.3.45 Abstract: As a results of high energy traumas on head and neck, blunt carotid artey dissection (CAD) may occur. The incidence of CAD among all patients with blunt trauma is estimated to be 0.08–1.2%. Motor vehicle accidents are the cause of carotid dissections at rates varying between 53% and 82%. CAD may lead to ischemic stroke and subsequent disability or death. Case fatality has been reported in up to 31% of the patients with CAD, and severe disability in up to 56% of the survivors. To prevent these serious complications, early recognition of this injury is important. In the present case, the patient with general trauma after motor vehicle accident was brought to emergency service with open consciousness. Glascow Coma Score was 13 and no pathology was seen in brain and cervical tomography images. Due to blunt abdominal injury, owing to sudden fall in hemoglobin values, the patient underwent emergency operation by general surgery team. In postoperat...
Blunt Vascular Neck Injuries: Diagnosis and Outcomes of Extracranial Vessel Injury
The Journal of Trauma: Injury, Infection, and Critical Care, 2002
Background: Blunt vascular neck injuries (BVNIs) are rare, often occult, and potentially devastating injuries. The purpose of this study was to identify a highrisk group, which would benefit from screening. Methods: Patients with BVNIs were identified from our trauma registry and charts were reviewed. Potential risk factors for BVNI were evaluated by univariate and multivariate logistic regression. Results: Thirty-one BVNIs were identified in 22 patients. The stroke rate was 60% and the mortality rate was 25%. Univariate analysis showed Glasgow Coma Scale score < 8, head injury (Abbreviated Injury Scale [AIS] score > 3), basal skull fracture, facial injury, other neck injury, thorax injury (AIS score > 3), abdominal injury, and cervical spine injury to be significant (p < 0.05). The multivariate predictive model had two predictors remaining significant: thorax injury (AIS [thorax] score > 3) and Glasgow Coma Scale score < 8. Conclusion: Screening should be undertaken for patients at increased risk for BVNI: those with risk factors identified in our regression analysis and factors previously reported.