Robbertze Rubinette, Lubout Megan, Prince Daniel Nicholas, Joubert Isabella Margaretha, Moeng Maeyane S
Division of Diagnostic Radiology, Department of Radiation Sciences, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Trauma Surgery, Trauma Surgeon Mater Misericordiae University Hospital, Dublin, Ireland.
World J Surg. 2025 Jul;49(7):1943-1950. doi: 10.1002/wjs.12623. Epub 2025 May 19.
South Africa faces a high burden of trauma-related vascular injury. Prompt diagnosis and management are crucial to limit morbidity and mortality. Literature recommends a thorough vascular examination of at-risk patients. Ankle brachial index (ABI) and arterial pressure index (API) are considered reliable screening tools for lower extremity vascular injury (LEVI) in the correct clinical scenario. Patients with an abnormal ABI/API warrant diagnostic imaging with computed tomography angiography (CTA). However, recent international literature demonstrates a trend toward potential CTA overuse in the work up for LEVI, when the internationally recommended vascular injury work-up guidelines are not followed correctly.
To assess the reliability of ABI/API in trauma patients with suspected LEVI as a screening tool to safely avoid unnecessary CTA.
A retrospective cohort study of all lower extremity trauma patients with soft signs of LEVI who presented to Charlotte Maxeke Johannesburg Academic Hospital from February 1, 2018 to January 31, 2020 was undertaken. Sensitivity, specificity, NPV, and PPV were calculated for ABI/API versus CTA and ABI/API/CTA versus surgically significant arterial injury. A p-value < 0.05 indicated statistical significance (confidence level = 95%).
Four hundred and thirty-three CTAs were performed for suspected traumatic LEVI. Two hundred and eighty-two were excluded due to missing data (precluding retrospective calculation of ABI/API) and 151 patients were included. To detect surgically significant injury, CTA had a 100% sensitivity, 97.2% specificity, 100% NPV, and 69.2% PPV; ABI and API had a 100% sensitivity, 83.8%-85.9% specificity, 100% NPV, and 28.1%-35.9% PPV, respectively. Neither ABI nor API missed surgically significant arterial injuries.
This affirms the reliability of ABI/API as a screening tool to identify patients at risk of LEVI from penetrating trauma. Findings supported international data demonstrating CTA overuse in this subset of patients.
南非面临着与创伤相关的血管损伤的沉重负担。及时诊断和处理对于降低发病率和死亡率至关重要。文献推荐对高危患者进行全面的血管检查。在正确的临床情况下，踝臂指数（ABI）和动脉压力指数（API）被认为是下肢血管损伤（LEVI）可靠的筛查工具。ABI/API异常的患者需要进行计算机断层血管造影（CTA）诊断性成像。然而，最近的国际文献表明，在LEVI的检查中，如果未正确遵循国际推荐的血管损伤检查指南，存在CTA潜在过度使用的趋势。
评估ABI/API在疑似LEVI的创伤患者中作为筛查工具以安全避免不必要CTA的可靠性。
对2018年2月1日至2020年1月31日期间就诊于夏洛特·马克西克·约翰内斯堡学术医院的所有有LEVI软体征的下肢创伤患者进行回顾性队列研究。计算ABI/API与CTA以及ABI/API/CTA与手术相关动脉损伤的敏感性、特异性、阴性预测值和阳性预测值。p值<0.05表示具有统计学意义（置信水平=95%）。
对疑似创伤性LEVI进行了433次CTA检查。由于数据缺失（无法进行ABI/API的回顾性计算），排除了282例，纳入151例患者。为检测手术相关损伤，CTA的敏感性为100%，特异性为97.2%，阴性预测值为100%，阳性预测值为69.2%；ABI和API的敏感性均为100%，特异性分别为83.8%-85.9%，阴性预测值为100%，阳性预测值分别为28.1%-35.9%。ABI和API均未漏诊手术相关动脉损伤。
这证实了ABI/API作为一种筛查工具在识别穿透性创伤中LEVI风险患者方面的可靠性。研究结果支持了国际数据，表明在这部分患者中存在CTA过度使用的情况。
