The Utility of a Screening Neck Computed Tomographic Angiogram in Blunt Trauma Patients Presenting With a Seat Belt Sign in the Absence of Associated Risk Factors.

Abstract

Blunt cerebrovascular injuries (BCVI) of the neck are a common cause for concern after blunt trauma. The purpose of this article is to demonstrate whether patients with a cervical seat belt sign in the absence of associated high-risk injuries or neurological symptoms are at an increased risk for developing a clinically significant vascular injury and therefore require a screening neck computed tomographic angiography (CTA). A retrospective review was performed of patients who presented after motor vehicle collision and received a neck CTA for an indication of "seat belt sign." Imaging was reviewed to determine the vascular injury grade, associated injuries, and, if available, follow-up imaging was reviewed to assess for interval change or resolution. The patients were split into 2 groups. Group 1 included patients without high-risk injuries, and group 2 included patients with high-risk injuries. In group 1, 6 (2.9%) of 208 patients had BCVI. In group 2, 7 (18.9%) of 37 patients had BCVI. Patients in group 2 were 6.5 times more likely to suffer BCVI compared with group 1 (P < 0.001). No patient in group 1 was ever symptomatic, and only 1 (0.5%) patient underwent interventional treatment. Patients presenting after blunt trauma with a seat belt sign and no other high-risk injuries as laid out by screening criteria demonstrate a low probability of BCVI and an even lower likelihood of adverse outcome.