Screening CT Angiography for Detection of Blunt Carotid and Vertebral Artery Injury in the Setting of Combat-Related Trauma

Abstract

Blunt carotid and vertebral artery injury (BCVI) is a relatively rare injury reported in the civilian sector and is associated with high morbidity and mortality. The purpose of our study was to use an optimized computed tomography angiography protocol in the deployed setting to determine the prevalence of BCVI in a consecutive patient population having experienced recent wartime-related traumatic injuries. From July 2008 to September 2009, a total of 307 consecutive trauma patients were included in this study. At least 233 (76%) patients were known to have experienced blast-related traumatic injuries. 135 (44%) patients had injuries to the head, face, or neck. 4 patients (1.3%) sustained BCVI. There was no statistically significant difference between the prevalence of BCVI in the deployed setting and the civilian sector. We speculate that in our study population, the relatively decreased prevalence of cervical spinal fractures (3.3%) observed may counter the theoretical increased risk of vascular injury from blast trauma, ultimately producing a similar prevalence of overall BCVI compared to civilian study populations. Based on our observations, we cannot advocate for or against more liberalized screening of BCVI in the deployed setting, and military physicians may elect to continue screening for these injuries with currently established and accepted practice guidelines developed in civilian trauma populations.