The protocol called for CTA in all trauma patients with cranial or cervical trauma undergoing CT scanning. Any abnormality was further investigated with ART, and patients were followed for neurologic changes. The investigators reviewed records to determine if clinical injuries were missed by CTA, and then compared ART and CTA images.
Between June 2004 and February 2005, the team did 225 CTAs. A total of 17 patients (7.5%) were diagnosed with blunt cerebrovascular injuries, including 11 carotid and 6 vertebral injuries. CTA did not miss any clinically important blunt cerebrovascular injury, the researchers said.
“Importantly, nobody during the study period who had had a normal CTA developed signs or symptoms of a vascular injury, and that was what we set out to explore,” Dr. Biffl said. “The disconcerting thing in this study is that two patients who didn't meet the screening criteria presented with symptoms related to a vascular injury.”
One of those patients was an elderly man who had been in a minor auto accident. He was evaluated and sent home from the emergency department, but returned with persistent headache and Horner Syndrome. He was found to have dissection of the carotid artery. The other patient was a young woman who had fractures of the femur and clavicle who, because she didn't have cranial or cervical trauma, didn't undergo a CTA. She woke up the next day in the orthopedic service with a stroke.
“We've concluded from this study that CTA is a reliable, noninvasive screening test for clinically significant blunt cervical vascular injuries,” Dr. Biffl said. “We need multicenter prospective trials to clarify the risk factors and to assess the accuracy of noninvasive screening tests and to evaluate the efficacy of treatment strategies,” he added.