Is CT Angiography of the Head Useful in the Management of Traumatic Brain Injury? - 20/05/15

Doi : 10.1016/j.jamcollsurg.2015.03.002

Leily Naraghi, MD, Andreas Larentzakis, MD, PhD, Yuchiao Chang, PhD, Anne-Christine Duhaime, MD, Haytham Kaafarani, MD, MPH, Daniel D. Yeh, MD, David R. King, MD, FACS, Marc A. de Moya, MD, FACS, George C. Velmahos, MD, PhD, FACS ^⁎
Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA

^∗Correspondence address: George C Velmahos, MD, PhD, FACS, Massachusetts General Hospital, 165 Cambridge St, Suite 810, Boston, MA 02114.

Abstract

Background

Computed tomography angiography (CTA) has been increasingly used in traumatic brain injury (TBI) patients to uncover vascular lesions that might have preceded the trauma and caused the bleed. This study aims to evaluate the usefulness of head CTA in the initial care of blunt TBI patients.

Study Design

We conducted a retrospective case-control analysis of adult TBI patients, admitted to our Level I trauma center from January 1, 2012 to December 31, 2012. The patients were grouped as those with and without a CTA of the head. The primary outcomes included a change in management after the findings of head CTA and secondary outcomes included rate of admission to the ICU, ICU length of stay, hospital length of stay, discharge disposition, and mortality.

Results

Six hundred adult patients had blunt TBI and underwent head CT as a part of their evaluation. Of these 600 patients, 132 (22%) underwent head CTA in addition to CT. Only one patient had altered management after the CTA results; the patient had a diagnostic angiogram that was negative. Ninety-eight patients did not have any additional findings on CTA. Of the remaining 33 patients with additional CTA findings, 12 had incidental vascular malformations, which showed no acute pathology and were not related to the injury. In the matched comparisons, patients with CTA had a longer hospital stay, higher rate of ICU admission, and longer ICU stay. There was no significant difference in mortality and discharge disposition between the 2 groups.