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Diagnostic performance of CT angiography in neck vessel trauma: systematic review and meta-analysis

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Abstract

This study was conducted in order to define the diagnostic performance of CT angiography for vascular injuries compared with angiography in patients with neck trauma. CT angiography is the cornerstone of diagnosis for hemodynamically stable patients with wounds suspicious of vascular trauma in the limbs, chest, or abdomen. Available evidence for the use of CT angiography in neck vascular trauma comes from small case series and few randomized controlled trials, and high-quality information does not exist regarding its performance. A protocol using the recommendations of the Cochrane Collaboration was designed. A systematic search of diagnostic studies without limits on language or time was carried out to December 2014. Studies including patients with neck trauma with retrospective or prospective data collection that assessed CT angiography compared with other methods were selected. Methodological quality was assessed using the QUADAS-2 tool. A hierarchical model ROC curve and a bivariate random effects model were used for the pooled analysis. Sixteen studies were selected and reviewed, and nine studies with 693 patients were included in this review. The overall sensitivity was 97 % (95 % CI 0.77–1.00; I 2 = 65.7 % (41.4–90.0)), while the overall specificity was 99 % (95 % CI 0.93–1.00; I 2 = 0). The hierarchic ROC curve showed an area under the curve of 0.99. Publication bias was not identified in this study. CT angiography can be stated as the gold standard for diagnosing vascular injuries in hemodynamically stable patients with neck trauma.

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References

  1. Demetriades D, Theodorou D, Cornwell E, Berne TV, Asensio J, Belzberg H, Velmahos G, Weaver F, Yellin A (1997) Evaluation of penetrating injuries of the neck: prospective study of 223 patients. World J Surg 21(1):41–47

    Article  CAS  PubMed  Google Scholar 

  2. Markov NP, DuBose JJ, Scott D, Propper BW, Clouse WD, Thompson B, Blackbourne LH, Rasmussen TE (2012) Anatomic distribution and mortality of arterial injury in the wars in Afghanistan and Iraq with comparison to a civilian benchmark. J Vasc Surg 56(3):728–736. doi:10.1016/j.jvs.2012.02.048

    Article  PubMed  Google Scholar 

  3. Thal ER, Meyer DM (1992) Penetrating neck trauma. Curr Probl Surg 29(1):1–56

    Article  CAS  PubMed  Google Scholar 

  4. McConnell DB, Trunkey DD (1994) Management of penetrating trauma to the neck. Adv Surg 27:97–127

    CAS  PubMed  Google Scholar 

  5. Apffelstaedt JP, Muller R (1994) Results of mandatory exploration for penetrating neck trauma. World J Surg 18(6):917–919

    Article  CAS  PubMed  Google Scholar 

  6. Asensio JA, Valenziano CP, Falcone RE, Grosh JD (1991) Management of penetrating neck injuries. The controversy surrounding zone II injuries. Surg Clin North Am 71(2):267–296

    Article  CAS  PubMed  Google Scholar 

  7. Shiroff AM, Gale SC, Martin ND, Marchalik D, Petrov D, Ahmed HM, Rotondo MF, Gracias VH (2013) Penetrating neck trauma: a review of management strategies and discussion of the ‘no zone’ approach. Am Surg 79(1):23–29

    PubMed  Google Scholar 

  8. Eddy VA (2000) Is routine arteriography mandatory for penetrating injury to zone 1 of the neck? Zone 1 Penetrating Neck Injury Study Group. J Trauma 48(2):208–213

    Article  CAS  PubMed  Google Scholar 

  9. Weaver FA, Yellin AE, Wagner WH, Brooks SH, Weaver AA, Milford MA (1988) The role of arterial reconstruction in penetrating carotid injuries. Arch Surg (Chicago, Ill: 1960) 123(9):1106–1111

    Article  CAS  Google Scholar 

  10. Gasparri MG, Lorelli DR, Kralovich KA, Patton JH Jr (2000) Physical examination plus chest radiography in penetrating periclavicular trauma: the appropriate trigger for angiography. J Trauma 49(6):1029–1033

    Article  CAS  PubMed  Google Scholar 

  11. Woo K, Magner DP, Wilson MT, Margulies DR (2005) CT angiography in penetrating neck trauma reduces the need for operative neck exploration. Am Surg 71(9):754–758

    PubMed  Google Scholar 

  12. Schroeder JW, Baskaran V, Aygun N (2010) Imaging of traumatic arterial injuries in the neck with an emphasis on CTA. Emerg Radiol 17(2):109–122. doi:10.1007/s10140-009-0835-5

    Article  PubMed  Google Scholar 

  13. Osborn TM, Bell RB, Qaisi W, Long WB (2008) Computed tomographic angiography as an aid to clinical decision making in the selective management of penetrating injuries to the neck: a reduction in the need for operative exploration. J Trauma 64(6):1466–1471. doi:10.1097/TA.0b013e3181271b32

    Article  PubMed  Google Scholar 

  14. Inaba K, Branco BC, Reddy S, Park JJ, Green D, Plurad D, Talving P, Lam L, Demetriades D (2011) Prospective evaluation of multidetector computed tomography for extremity vascular trauma. J Trauma 70(4):808–815. doi:10.1097/TA.0b013e3182118384

    Article  PubMed  Google Scholar 

  15. Lyons JD, Feliciano DV, Wyrzykowski AD, Rozycki GS (2013) Modern management of penetrating tracheal injuries. Am Surg 79(2):188–193

    PubMed  Google Scholar 

  16. Bryant AS, Cerfolio RJ (2007) Esophageal trauma. Thorac Surg Clin 17(1):63–72. doi:10.1016/j.thorsurg.2007.02.003

    Article  PubMed  Google Scholar 

  17. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012

    Article  CAS  PubMed  Google Scholar 

  18. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269, w264

    Article  PubMed  Google Scholar 

  19. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7), e1000100. doi:10.1371/journal.pmed.1000100

    Article  PubMed  PubMed Central  Google Scholar 

  20. Leeflang MM, Deeks JJ, Gatsonis C, Bossuyt PM (2008) Systematic reviews of diagnostic test accuracy. Ann Intern Med 149(12):889–897

    Article  PubMed  PubMed Central  Google Scholar 

  21. Group TCCDTAW (2011) Handbook for diagnostic test accuracy reviews. In: Collaboration TC (ed)

  22. DuBose JJ, Savage SA, Fabian TC, Menaker J, Scalea T, Holcomb JB, Skarupa D, Poulin N, Chourliaras K, Inaba K, Rasmussen TE (2015) The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry: multicenter data on modern vascular injury diagnosis, management, and outcomes. J Trauma Acute Care Surg 78(2):215–222. doi:10.1097/ta.0000000000000520, discussion 222-213

    Article  PubMed  Google Scholar 

  23. Tisherman SA, Bokhari F, Collier B, Cumming J, Ebert J, Holevar M, Kurek S, Leon S, Rhee P (2008) Clinical practice guideline: penetrating zone II neck trauma. J Trauma 64(5):1392–1405. doi:10.1097/TA.0b013e3181692116

    Article  PubMed  Google Scholar 

  24. Schueler S, Schuetz GM, Dewey M (2012) The revised QUADAS-2 tool. Ann Intern Med 156(4):323. doi:10.7326/0003-4819-156-4-201202210-00018, author reply 323–324

    Article  PubMed  Google Scholar 

  25. Wang F, Gatsonis CA (2008) Hierarchical models for ROC curve summary measures: design and analysis of multi-reader, multi-modality studies of medical tests. Stat Med 27(2):243–256. doi:10.1002/sim.2828

    Article  CAS  PubMed  Google Scholar 

  26. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. doi:10.1002/sim.1186

    Article  PubMed  Google Scholar 

  27. Ofer A, Nitecki SS, Braun J, Daitzchman M, Goldsher D, Hoffman A, Engel A (2001) CT angiography of the carotid arteries in trauma to the neck. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg 21(5):401–407. doi:10.1053/ejvs.2001.1330

    Article  CAS  Google Scholar 

  28. Mazolewski PJ, Curry JD, Browder T, Fildes J (2001) Computed tomographic scan can be used for surgical decision making in zone II penetrating neck injuries. J Trauma 51(2):315–319

    Article  CAS  PubMed  Google Scholar 

  29. Gonzalez RP, Falimirski M, Holevar MR, Turk B (2003) Penetrating zone II neck injury: does dynamic computed tomographic scan contribute to the diagnostic sensitivity of physical examination for surgically significant injury? A prospective blinded study. J Trauma 54(1):61–64. doi:10.1097/01.ta.0000046310.28475.8d, discussion 64-65

    Article  PubMed  Google Scholar 

  30. Gracias VH, Reilly PM, Philpott J, Klein WP, Lee SY, Singer M, Schwab CW (2001) Computed tomography in the evaluation of penetrating neck trauma: a preliminary study. Arch Surg (Chicago, Ill: 1960) 136(11):1231–1235

    Article  CAS  Google Scholar 

  31. Inaba K, Munera F, McKenney M, Rivas L, de Moya M, Bahouth H, Cohn S (2006) Prospective evaluation of screening multislice helical computed tomographic angiography in the initial evaluation of penetrating neck injuries. J Trauma 61(1):144–149. doi:10.1097/01.ta.0000222711.01410.bc

    Article  PubMed  Google Scholar 

  32. Inaba K, Branco BC, Menaker J, Scalea TM, Crane S, DuBose JJ, Tung L, Reddy S, Demetriades D (2012) Evaluation of multidetector computed tomography for penetrating neck injury: a prospective multicenter study. J Trauma Acute Care Surg 72(3):576–583. doi:10.1097/TA.0b013e31824badf7, discussion 583-574; quiz 803-574

    Article  PubMed  Google Scholar 

  33. Stuhlfaut JW, Barest G, Sakai O, Lucey B, Soto JA (2005) Impact of MDCT angiography on the use of catheter angiography for the assessment of cervical arterial injury after blunt or penetrating trauma. AJR Am J Roentgenol 185(4):1063–1068. doi:10.2214/ajr.04.1217

    Article  PubMed  Google Scholar 

  34. Munera F, Soto JA, Palacio D, Velez SM, Medina E (2000) Diagnosis of arterial injuries caused by penetrating trauma to the neck: comparison of helical CT angiography and conventional angiography. Radiology 216(2):356–362. doi:10.1148/radiology.216.2.r00jl25356

    Article  CAS  PubMed  Google Scholar 

  35. Munera F, Soto JA, Palacio DM, Castaneda J, Morales C, Sanabria A, Gutierrez JE, Garcia G (2002) Penetrating neck injuries: helical CT angiography for initial evaluation. Radiology 224(2):366–372. doi:10.1148/radiol.2242010973

    Article  PubMed  Google Scholar 

  36. Seamon MJ, Smoger D, Torres DM, Pathak AS, Gaughan JP, Santora TA, Cohen G, Goldberg AJ (2009) A prospective validation of a current practice: the detection of extremity vascular injury with CT angiography. J Trauma 67(2):238–243. doi:10.1097/TA.0b013e3181a51bf9, discussion 243-234

    Article  PubMed  Google Scholar 

  37. Maturen KE, Adusumilli S, Blane CE, Arbabi S, Williams DM, Fitzgerald JT, Vine AA (2007) Contrast-enhanced CT accurately detects hemorrhage in torso trauma: direct comparison with angiography. J Trauma 62(3):740–745. doi:10.1097/01.ta.0000235508.11442.a8

    Article  PubMed  Google Scholar 

  38. Uyeda JW, Anderson SW, Sakai O, Soto JA (2010) CT angiography in trauma. Radiol Clin N Am 48(2):423–438. doi:10.1016/j.rcl.2010.02.003, ix–x

    Article  PubMed  Google Scholar 

  39. Bell RB, Osborn T, Dierks EJ, Potter BE, Long WB (2007) Management of penetrating neck injuries: a new paradigm for civilian trauma. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg 65(4):691–705. doi:10.1016/j.joms.2006.04.044

    Article  Google Scholar 

  40. Jens S, Kerstens MK, Legemate DA, Reekers JA, Bipat S, Koelemay MJ (2013) Diagnostic performance of computed tomography angiography in peripheral arterial injury due to trauma: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg 46(3):329–337. doi:10.1016/j.ejvs.2013.04.034

    Article  CAS  Google Scholar 

  41. Fox N, Schwartz D, Salazar JH, Haut ER, Dahm P, Black JH, Brakenridge SC, Como JJ, Hendershot K, King DR, Maung AA, Moorman ML, Nagy K, Petrey LB, Tesoriero R, Scalea TM, Fabian TC (2015) Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 78(1):136–146. doi:10.1097/ta.0000000000000470

    Article  PubMed  Google Scholar 

  42. Nunez DB Jr, Torres-Leon M, Munera F (2004) Vascular injuries of the neck and thoracic inlet: helical CT-angiographic correlation. Radiographics: a Rev Publ Radiol Soc N Am, Inc 24(4):1087–1098. doi:10.1148/rg.244035035, discussion 1099-1100

    Article  Google Scholar 

  43. LeBlang SD, Nunez DB Jr (2000) Noninvasive imaging of cervical vascular injuries. AJR Am J Roentgenol 174(5):1269–1278. doi:10.2214/ajr.174.5.1741269

    Article  CAS  PubMed  Google Scholar 

  44. Miller PR, Fabian TC, Croce MA, Cagiannos C, Williams JS, Vang M, Qaisi WG, Felker RE, Timmons SD (2002) Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg 236(3):386–393. doi:10.1097/01.SLA.0000027174.01008.A0, discussion 393-385

    Article  PubMed  PubMed Central  Google Scholar 

  45. Friedman D, Flanders A, Thomas C, Millar W (1995) Vertebral artery injury after acute cervical spine trauma: rate of occurrence as detected by MR angiography and assessment of clinical consequences. AJR Am J Roentgenol 164(2):443–447. doi:10.2214/ajr.164.2.7839986, discussion 448–449

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, Universidad de Antioquia, Hospital San Vicente de Paul, Calle 64 # 51 D - 154, Medellín, Colombia

    Carlos Morales-Uribe, Ana Ramírez & Alvaro Sanabria

  2. Department of Radiology, School of Medicine, Universidad de Antioquia, Hospital San Vicente de Paul, Medellín, Colombia

    Tatiana Suarez-Poveda & Margarita Ortiz

  3. Head and Neck Service, Fundación Colombiana de Cancerología-Clínica Vida, Medellín, Colombia

    Alvaro Sanabria

Authors
  1. Carlos Morales-Uribe
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  2. Ana Ramírez
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  3. Tatiana Suarez-Poveda
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  4. Margarita Ortiz
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Correspondence to Carlos Morales-Uribe.

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This work was funded by the School of Medicine, Universidad de Antioquia.

Appendix: Searching strategy

Appendix: Searching strategy

  • #11,“Search ((((((““diagnoYess/broad””[Filter]) AND (neck CT angiography and injuries)))) OR ((““diagnoYess/narrow””[Filter]) AND (neck CT angiography and injuries))) OR ((neck ct angiography) AND (((Wounds and Injuries)) AND Neck))) OR ((Tomography, X-Ray Computed) AND (((Wounds and Injuries)) AND Neck))) OR ((Angiography) AND (((Wounds and Injuries)) AND Neck))”,3292,03:59:47

  • #10,“Search (neck ct angiography) AND (((Wounds and Injuries)) AND Neck)”,173,03:57:04

  • #9,“Search neck ct angiography”,1050,03:56:46

  • #8,“Search (Tomography, X-Ray Computed) AND (((Wounds and Injuries)) AND Neck)”,2500,03:55:23

  • #7,“Search ((((Wounds and Injuries)) AND Neck)) AND ((Angiography) AND (((Wounds and Injuries)) AND Neck))”,1122,03:54:47

  • #6,“Search (““diagnoYess/narrow””[Filter]) AND (neck CT angiography and injuries)”,10,03:53:11

  • #5,“Search (““diagnoYess/broad””[Filter]) AND (neck CT angiography and injuries))”,112,03:51:15

  • #3,“Search Tomography, X-Ray Computed”,298074,03:48:06

  • #2,“Search (Angiography) AND (((Wounds and Injuries)) AND Neck)”,1122,03:47:19

  • #1,“Search ((Wounds and Injuries)) AND Neck”,30647,03:46:11

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Morales-Uribe, C., Ramírez, A., Suarez-Poveda, T. et al. Diagnostic performance of CT angiography in neck vessel trauma: systematic review and meta-analysis. Emerg Radiol 23, 421–431 (2016). https://doi.org/10.1007/s10140-016-1412-3

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