Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, San Francisco 94143, CA, United States.
Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, San Francisco 94143, CA, United States.
Injury. 2021 Jul;52(7):1727-1731. doi: 10.1016/j.injury.2021.04.057. Epub 2021 May 1.
CT angiography (CTA) is increasingly used in the evaluation of arterial injury in extremity trauma. While it may provide additional objective data, it comes with inherent risks and expense. The purpose of this study was to compare CTA to physical exam in the evaluation of arterial injury in extremity trauma.
We performed a retrospective review of patients who underwent CTA for evaluation of upper or lower extremity trauma at a Level 1 trauma center over a 10 month period. Patients were classified based on initial vascular exam (normal, soft signs, hard signs), and arterial injury on CTA was classified as major (named arteries) or minor (un-named arteries). We evaluated rates of vascular intervention in each group and compared the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for physical exam and CTA in identifying arterial injury requiring intervention.
A total of 135 CTA studies were included. On initial vascular exam, 71% of patients had a normal exam, 22% had soft signs, and 6% had hard signs. The NPVs for arterial injury requiring intervention of a normal physical exam and negative CTA were both 100%. The PPVs for arterial injury requiring intervention of major injury on CTA and hard signs on physical exam were 35% and 50%, respectively.
A normal physical exam can likely rule out the need for vascular intervention and eliminate the need for CTA. Additionally, the presence of hard signs on physical exam is potentially superior to CTA in predicting the need for vascular intervention.
CT 血管造影（CTA）在评估四肢创伤中的动脉损伤方面的应用越来越多。虽然它可以提供额外的客观数据，但也存在固有风险和费用。本研究旨在比较 CTA 和体格检查在评估四肢创伤中的动脉损伤。
我们对在 10 个月期间在 1 级创伤中心接受 CTA 评估上肢或下肢创伤的患者进行了回顾性研究。根据初始血管检查（正常、软体征、硬体征）对患者进行分类，并根据 CTA 上的动脉损伤将其分为主要（命名动脉）或次要（未命名动脉）。我们评估了每组血管介入的发生率，并比较了体格检查和 CTA 在识别需要干预的动脉损伤方面的敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）。
共纳入 135 例 CTA 研究。在初始血管检查中，71%的患者检查正常，22%的患者有软体征，6%的患者有硬体征。需要血管干预的动脉损伤的正常体格检查和阴性 CTA 的 NPV 均为 100%。CTA 上主要损伤和体格检查上硬体征需要干预的动脉损伤的 PPV 分别为 35%和 50%。
正常的体格检查可能可以排除血管干预的需要，并消除 CTA 的需要。此外，体格检查上硬体征的存在在预测血管干预的需要方面可能优于 CTA。
