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 to cite this document:

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

DOI to cite this document:

10.5283/epub.44037 Copy

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

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License: Creative Commons Attribution 4.0 PDF - Published Version (910kB)

Date of publication of this fulltext: 02 Nov 2020 11:26

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Details

Item type:	Article
Open Access Type:	Gold (with APC)
Journal or Publication Title:	Journal of Clinical Medicine
Publisher:	MDPI
Place of Publication:	BASEL
Volume:	9
Number of Issue or Book Chapter:	8
Page Range:	p. 2568
Date:	8 August 2020
Institutions:	Medicine > Lehrstuhl für Unfallchirurgie Medicine > Lehrstuhl für Röntgendiagnostik
Projects (Historical):	Open Access Publizieren (DFG)
Identification Number:	Value Type 10.3390/jcm9082568 DOI
Keywords:	BLUNT CEREBROVASCULAR INJURY; CAROTID-ARTERY; SCREENING CRITERIA; cervical artery dissection; vertebral artery; carotid artery; polytrauma; severely injured; computed tomography
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Yes
Item ID:	44037

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Abstract

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 ...

Abstract

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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Metadata last modified: 29 Sep 2021 07:42

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