Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck, Austria.
Arch Orthop Trauma Surg. 2010 Oct;130(10):1269-74. doi: 10.1007/s00402-010-1068-5. Epub 2010 Feb 19.
Blunt cervical vascular injuries (BCVI) from alpine sports accidents bear an increased risk for being underdiagnosed during initial radiological evaluation. At our hospital, the "Innsbruck Emergency Algorithm", which includes assessment of the neck as a computed tomography (CT) angiography during initial whole-body CT, has been introduced to avoid misdiagnoses and optimizes emergency radiology management.
Critically injured patients who were admitted for emergency CT after trauma from alpine skiing and mountain-biking accidents and who were reported with BCVI were included in this retrospective study.
During 2003-2009, 36 victims were eligible for inclusion. They presented with a mean (SD) of 4.6 (2.1) diagnoses per patient, of which 3.5 (2.3) were perceptible on radiology examinations only. The "Innsbruck Emergency Algorithm" was performed in 15 individuals while 21 underwent another CT protocol including a native scan of the neck or during a parenchymatous contrast-medium phase only. In addition to BCVI, most patients (71%) were diagnosed with fractures followed by unspecific contusion/s (54%), head injuries (43%), and injuries of parenchymatous organs (19%). In five (14%), BCVI was underdiagnosed during the initial radiological examination. All of the latter had CT during a parenchymatous contrast-medium phase and not according to the "Innsbruck Emergency Algorithm". Four of those patients died during their hospital stay. In 11, cerebral follow-up examinations showed cerebral pathologies considered as results from BCVI.
The "Innsbruck Emergency Algorithm" in patients with clinically unapparent BCVI after skiing and mountain-biking accidents avoided overlooking vascular injuries, which significantly improved their long-term outcome.
高山运动事故导致的钝性颈部血管损伤（BCVI）在初始放射学评估中存在被漏诊的风险增加。在我院，引入了“因斯布鲁克急救算法”，包括在初始全身 CT 检查时评估颈部进行 CT 血管造影，以避免误诊并优化急救放射学管理。
本回顾性研究纳入了因高山滑雪和山地自行车事故而接受紧急 CT 检查的严重创伤患者，并报告有 BCVI。
2003 年至 2009 年期间，36 名符合入选标准的患者。每位患者的平均（标准差）诊断数为 4.6（2.1），其中 3.5（2.3）仅在影像学检查中可察觉。15 名患者进行了“因斯布鲁克急救算法”，21 名患者进行了另一种 CT 方案，包括颈部平扫或仅在实质期对比剂期进行。除 BCVI 外，大多数患者（71%）被诊断为骨折，其次是未特定挫伤/瘀伤（54%）、头部损伤（43%）和实质器官损伤（19%）。在 5 名（14%）患者中，初始放射学检查漏诊了 BCVI。所有这些患者均在实质期对比剂期进行 CT 检查，而非根据“因斯布鲁克急救算法”。其中 4 名患者在住院期间死亡。在 11 例中，脑随访检查显示脑部病变被认为是 BCVI 的结果。
对于临床无明显 BCVI 的滑雪和山地自行车事故患者，“因斯布鲁克急救算法”避免了忽略血管损伤，显著改善了他们的长期预后。
