Awal Wasim, De Groot Julia
Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
Griffith University School of Medicine, Gold Coast, Queensland, Australia.
J Med Imaging Radiat Oncol. 2024 Mar;68(2):126-131. doi: 10.1111/1754-9485.13603. Epub 2023 Nov 20.
Computed tomography angiograms (CTAs) are useful in detecting vascular injury. There is a lack of consensus regarding the indications of CTAs in limb trauma, leading to overutilisation of CTAs in some centres and exposing patients to unnecessary harm. Thus, the aim of this study is to define the appropriate indications for CTAs in limb trauma.
This is a retrospective cohort study of consecutive CTAs performed in a tertiary hospital from January to December 2022. Demographic and clinical factors were collected from the patients' charts including physical examination findings and arterial pressure index (API) measurements. Physical examination findings include hard signs (e.g. absent pulse) or soft signs (e.g. non-expanding haematoma). These data were analysed to detect correlation with vascular injury on the patient's CTA.
Forty-nine CTAs were included, of which 10 (20.4%) found vascular injury. Hard signs (P < 0.001) and an API <0.9 (P = 0.02) were significantly correlated with vascular injury. Hard signs had a sensitivity of 90% and specificity of 82%, whereas APIs had a specificity and sensitivity of 100%. Soft signs were not correlated with vascular injury due to poor specificity but had a sensitivity of 100%. Knee dislocations were not associated with vascular injury (P = 0.5).
This small study suggests that CTAs are indicated if there are hard signs of vascular compromise or an API <0.9, provided the patient is haemodynamically stable. The presence of soft signs can help identify which patients should receive an API measurement. CTAs may not be routinely indicated in knee dislocations.
计算机断层血管造影（CTA）在检测血管损伤方面很有用。关于CTA在肢体创伤中的应用指征，目前尚无共识，这导致一些中心对CTA的过度使用，使患者受到不必要的伤害。因此，本研究的目的是确定CTA在肢体创伤中的合适应用指征。
这是一项对2022年1月至12月在一家三级医院连续进行的CTA检查的回顾性队列研究。从患者病历中收集人口统计学和临床因素，包括体格检查结果和动脉压指数（API）测量值。体格检查结果包括硬体征（如脉搏消失）或软体征（如非扩展性血肿）。对这些数据进行分析，以检测与患者CTA上血管损伤的相关性。
纳入49例CTA检查，其中10例（20.4%）发现血管损伤。硬体征（P < 0.001）和API < 0.9（P = 0.02）与血管损伤显著相关。硬体征的敏感性为90%，特异性为82%，而API的特异性和敏感性均为100%。软体征因特异性差与血管损伤无关，但敏感性为100%。膝关节脱位与血管损伤无关（P = 0.5）。
这项小型研究表明，如果存在血管受损的硬体征或API < 0.9，且患者血流动力学稳定，则应进行CTA检查。软体征的存在有助于确定哪些患者应接受API测量。膝关节脱位可能无需常规进行CTA检查。
