Modified Split-Scan Computed Tomography (CT) Diagnostics of Severely Injured Patients: First Results from a Level I Trauma Center Using a Dedicated Head-and-Neck CT-Angiogram for the Detection of Cervical Artery Dissections

URN zum Zitieren dieses Dokuments:

urn:nbn:de:bvb:355-epub-440379 Copy

DOI zum Zitieren dieses Dokuments:

10.5283/epub.44037 Copy

Popp, Daniel ; Thiedemann, Claudius ; Bäumler, Wolf ; Ernstberger, Antonio ; Alt, Volker ; Schicho, Andreas

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Lizenz: Creative Commons Namensnennung 4.0 International PDF - Veröffentlichte Version (910kB)

Veröffentlichungsdatum dieses Volltextes: 02 Nov 2020 11:26

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Alternative Links zum Volltext:DOIVerlagVerlag

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Details

Dokumentenart:	Artikel
Open Access Art:	Gold (mit APC - bezahlt UR)
Titel eines Journals oder einer Zeitschrift:	Journal of Clinical Medicine
Verlag:	MDPI
Ort der Veröffentlichung:	BASEL
Band:	9
Nummer des Zeitschriftenheftes oder des Kapitels:	8
Seitenbereich:	S. 2568
Datum:	8 August 2020
Institutionen:	Medizin > Lehrstuhl für Unfallchirurgie Medizin > Lehrstuhl für Röntgendiagnostik
Sonstige Projekte:	Open Access Publizieren (DFG)
Identifikationsnummer:	Wert Typ 10.3390/jcm9082568 DOI
Stichwörter / Keywords:	BLUNT CEREBROVASCULAR INJURY; CAROTID-ARTERY; SCREENING CRITERIA; cervical artery dissection; vertebral artery; carotid artery; polytrauma; severely injured; computed tomography
Dewey-Dezimal-Klassifikation:	600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin
Status:	Veröffentlicht
Begutachtet:	Ja, diese Version wurde begutachtet
An der Universität Regensburg entstanden:	Ja
Dokumenten-ID:	44037

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Zusammenfassung

Introduction: Traumatic cervical artery dissections are associated with high mortality and morbidity in severely injured patients. After finding even higher incidences than reported before, we decided to incorporate a dedicated head-and-neck computed tomography angiogram (CT-A) in our imaging routine for patients who have been obviously severely injured or, according to trauma mechanism, are ...

Zusammenfassung

Introduction: Traumatic cervical artery dissections are associated with high mortality and morbidity in severely injured patients. After finding even higher incidences than reported before, we decided to incorporate a dedicated head-and-neck computed tomography angiogram (CT-A) in our imaging routine for patients who have been obviously severely injured or, according to trauma mechanism, are suspected to be severely injured. Materials and Methods: A total of 134 consecutive trauma patients with an ISS >= 16 admitted to our level I trauma center during an 18 month period were included. All underwent standardized whole-body CT in a 256-detector row scanner with a dedicated head-and-neck CT-A realized as single-bolus split-scan routine. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded and analyzed in patients with carotid artery dissection (CAD) and vertebral artery dissection (VAD). Results: Of the 134 patients included, 7 patients had at least one cervical artery dissection (CeAD; 5.2%; 95% CI 1.5-9.0%). Six patients (85.7%) had carotid artery dissections, with one patient having a CAD of both sides and one patient having a CAD and contralateral VAD combined. Two patients (28.6%) showed a VAD. Overall mortality was 14.3%, neurologic morbidity was 28.6%. None of the patients showed any attributable neurologic symptoms on admission. The new scanning protocol led to further 5 patients with suspected CeAD during the study period, all ruled out by additional magnetic resonance imaging with angiogram (MRI/MR-A). Conclusion: A lack of specific neurologic symptoms on admission urges the need for a dedicated imaging pathway for severely injured patients, reliable for the detection of cervical artery dissections. Although our modified CT protocol with mandatory dedicated CT-A led to false positives requiring additional magnetic resonance imaging, it likely helped reduce possible therapeutic delays.

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Metadaten zuletzt geändert: 29 Sep 2021 07:42

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