SavedAdd your journal

Journals / Anatolian Current Medical Journal / 2026 / Volume: 8 Issue: 6

Diagnostic yield of computed tomography angiography in traumatic extremity vascular injuries and clinical and laboratory predictors: a retrospective cohort study

Burcu Özen Karabulut(AĞRI İBRAHİM ÇEÇEN ÜNİVERSİTESİ, TIP FAKÜLTESİ)0000-0002-9046-6511
Ali Ekber Karabulut(AGRI IBRAHIM CECEN UNIVERSITY, SCHOOL OF MEDICINE)0000-0002-7203-1178
Cem Yıldırım(SBU. Van Education and Research Hospital)0009-0004-5359-6335
Ahmet Aykut(SBU. Van Education and Research Hospital)0009-0001-3173-8994
Pages
—
Publication Date
2026-10-25
DOI
—
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Prospective, multicenter validation is warranted to inform selective CTA protocols in emergency trauma care.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Aims: This study aimed to evaluate the diagnostic yield of computed tomography angiography (CTA) in emergency department (ED) patients with suspected traumatic extremity vascular injury, and to identify clinical and laboratory predictors of CTA positivity and hospital admission.
📊
Key Findings & Data:Methods: This single-center, retrospective, observational cohort study included 201 consecutive ED presentations undergoing extremity CTA between January 1, 2022, and December 31, 2024.
💡
Conclusion & Impact:Prospective, multicenter validation is warranted to inform selective CTA protocols in emergency trauma care.
🔬Design:Modeling & Simulation
📍Scope:2022 Verileri
⚙️Variables:Computed tomography angiography · emergency medicine · extremities

Abstract

Aims: This study aimed to evaluate the diagnostic yield of computed tomography angiography (CTA) in emergency department (ED) patients with suspected traumatic extremity vascular injury, and to identify clinical and laboratory predictors of CTA positivity and hospital admission. Methods: This single-center, retrospective, observational cohort study included 201 consecutive ED presentations undergoing extremity CTA between January 1, 2022, and December 31, 2024. The primary outcome was CTA positivity, defined as detection of any pathological finding consistent with traumatic vascular injury; the secondary outcome was hospital admission. Candidate predictors included age, gender, injury mechanism, anatomical involvement, and first-draw ED laboratory values [glucose, WBC count, hemoglobin, hematocrit, neutrophil-to-lymphocyte ratio (NLR)]. Two multivariable logistic regression models were constructed for each outcome; performance was assessed via AUROC. Results: Of 201 patients (94.0% male; median age 28 years), 35 (17.4%) had CTA-positive findings. On univariable analysis, hematocrit (p=0.009), hemoglobin (p=0.031), and NLR (p=0.004) differed significantly between groups. On multivariable analysis, hematocrit was the sole independent predictor of CTA positivity (aOR 0.932; 95% CI 0.871-0.998; p=0.044; AUROC 0.711). Seventy patients (34.8%) were admitted; CTA positivity (aOR 5.094; p<0.001), low hematocrit (aOR 0.887; p<0.001), upper extremity involvement (aOR 2.698; p=0.030), and firearm mechanism independently predicted admission (AUROC 0.823). Conclusion: Diagnostic yield of extremity CTA remained low (17.4%), and hematocrit-an inexpensive, readily available laboratory parameter-was independently associated with CTA positivity within the studied clinical and laboratory profile, representing a preliminary finding pending external validation. Upper extremity involvement and firearm mechanism independently increased admission risk. Prospective, multicenter validation is warranted to inform selective CTA protocols in emergency trauma care.

🔖

Cite This Article

Karabulut, B. Ö., Karabulut, A. E., Yıldırım, C., Aykut, A. (2026). Diagnostic yield of computed tomography angiography in traumatic extremity vascular injuries and clinical and laboratory predictors: a retrospective cohort study. Anatolian Current Medical Journal, Volume: 8 Issue: 6. https://ajindex.com/articles/1667870

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (29)

  1. Wahlgren CM, Aylwin C, Davenport RA, et al. Editor's choice-European Society for Vascular Surgery (ESVS) 2025 clinical practice guidelines on the management of vascular trauma. Eur J Vasc Endovasc Surg. 2025; 69(2):179-237. doi:10.1016/j.ejvs.2024.12.018
  2. Pesmatzoglou M, Lioudaki S, Kontopodis N, et al. Misdiagnosis of acute limb ischemia from non-vascular specialists results in a delayed presentation and negatively affects patients' outcomes. Med Sci (Basel). 2025;13(1):21. doi:10.3390/medsci13010021
  3. Madhuripan N, Mehta P, Smolinski SE, Njuguna N. Computed tomography angiography of the extremities in emergencies. Semin Ultrasound CT MR. 2017;38(4):357-369. doi:10.1053/j.sult.2017.03.001
  4. Dreizin D, Smith EB, Champ K, Morrison JJ. Roles of trauma CT and CTA in salvaging the threatened or mangled extremity. Radiographics. 2022;42(2):E50-E67. doi:10.1148/rg.210092
  5. Callan AK, Bauer JM, Mir HR. Over-utilization of computed tomography angiography in extremity trauma. OTA Int. 2019;2(4):e030. doi:10.1097/OI9.0000000000000030
  6. Brian R, Bennett DJ, Kim WC, Stein DM. Computed tomography angiography is associated with low added utility for detecting clinically relevant vascular injuries among patients with extremity trauma. Trauma Surg Acute Care Open. 2021;6(1):e000828. doi:10.1136/tsaco-2021-000828
  7. Simsek Y, Gur A. Vascular injury of penetrating trauma of the extremities. Emerg Med Int. 2024;2024:9979585. doi:10.1155/emmi/9979585
  8. du Plessis J, Kalu A, McKee H, et al. Computed tomography angiography utilization in lower extremity trauma: insights from a Canadian level I trauma centre. Can Assoc Radiol J. 2026;77(1):187-194. doi:10.1177/08465371251342064
  9. Boggs HK, Tomihama RT, Abou-Zamzam AM Jr, et al. Analysis of traumatic axillo-subclavian vessel injuries: endovascular management is a viable option to open surgical reconstruction. Ann Vasc Surg. 2022; 79:25-30. doi:10.1016/j.avsg.2021.07.047
  10. le Roux A, Du Plessis AM, Pitcher R. Yield of CT angiography in penetrating lower extremity trauma. Emerg Radiol. 2021;28(4):743-749. doi:10.1007/s10140-021-01902-9
  11. Xu J, Li S, Lui KY, et al. The neutrophil-to-lymphocyte ratio: a potential predictor of poor prognosis in adult patients with trauma and traumatic brain injury. Front Surg. 2022;9:917172. doi:10.3389/fsurg.2022.917172
  12. Wallin D, Yaghoubian A, Rosing D, Walot I, Chauvapun J, de Virgilio C. Computed tomographic angiography as the primary diagnostic modality in penetrating lower extremity vascular injuries: a level I trauma experience. Ann Vasc Surg. 2011;25(5):620-623. doi:10.1016/j.avsg.2011.02.022
  13. Alcasid NJ, Susai CJ, Banks KC, Senekjian L, Browder TD, Victorino GP. Cost-effectiveness analysis of routine computed tomography angiography (CTA) for lower extremity penetrating trauma. Am J Emerg Med. 2024;82: 33-36. doi:10.1016/j.ajem.2024.05.009
  14. Awal W, De Groot J. Indications for computed tomography angiography in limb trauma. J Med Imaging Radiat Oncol. 2024;68(2):126-131. doi:10.1111/1754-9485.13603
  15. deSouza IS, Benabbas R, McKee S, et al. Accuracy of physical examination, ankle-brachial index, and ultrasonography in the diagnosis of arterial injury in patients with penetrating extremity trauma: a systematic review and meta-analysis. Acad Emerg Med. 2017; 24(8):994-1017. doi:10.1111/acem.13227
  16. Jordaan P, Roche S, Maqungo S. Computerised tomographic angiography (CTA) in extremity trauma - a level one hospital experience. S Afr J Surg. 2016;54(4):11-16.
  17. Broudy T, Gonsalves L, King J, Hughes K, Evans A. An atypical presentation of vascular injury in extremity trauma beyond current guidelines. Cureus. 2025;17(8):e90413. doi:10.7759/cureus.90413
  18. Thorson CM, Ryan ML, Van Haren RM, et al. Change in hematocrit during trauma assessment predicts bleeding even with ongoing fluid resuscitation. Am Surg. 2013;79(4):398-406. doi:10.1177/000313481307900430
  19. Ryan ML, Thorson CM, Otero CA, et al. Initial hematocrit in trauma: a paradigm shift? J Trauma Acute Care Surg. 2012;72(1):54-60. doi:10.1097/TA.0b013e31823d0f35
  20. Kawai Y, Fukushima H, Asai H, et al. Significance of initial hemoglobin levels in severe trauma patients without prehospital fluid administration: a single-center study in Japan. Trauma Surg Acute Care Open. 2021;6(1):e000831. doi:10.1136/tsaco-2021-000831
  21. Staziaki PV, Qureshi MM, Maybury A, et al. Hematocrit and lactate trends help predict outcomes in trauma independent of CT and other clinical parameters. Front Radiol. 2023;3:1186277. doi:10.3389/fradi.2023.1186277
  22. Qiu Y, Fitzgerald M, Mitra B. Association of the neutrophil-lymphocyte ratio to patient outcomes after trauma: a systematic review. Trauma. 2022;24(3):195-203. doi:10.1177/14604086211034008
  23. Hosseini M, Fazeli P, Hajivalili M, Paydar S. The prognostic values of neutrophil to lymphocyte ratio in traumatically injured patients upon admission: a mini-review. Eur J Inflamm. 2023;21:1-15. doi:10.1177/1721727X231197494
  24. El-Menyar A, Asim M, Mir F, et al. Patterns and effects of admission hyperglycemia and inflammatory response in trauma patients: a prospective clinical study. World J Surg. 2021;45(9):2670-2681. doi:10.1007/s00268-021-06190-5
  25. Siracuse JJ, Farber A, Cheng TW, Jones DW, Kalesan B. Lower extremity vascular injuries caused by firearms have a higher risk of amputation and death compared with non-firearm penetrating trauma. J Vasc Surg. 2020;72(4):1298-1304.e1. doi:10.1016/j.jvs.2019.12.036
  26. Nyberger K, Caragounis EC, Djerf P, Wahlgren CM. Management and outcomes of firearm-related vascular injuries. Scand J Trauma Resusc Emerg Med. 2023;31(1):35. doi:10.1186/s13049-023-01098-6
  27. Tamburrini S, Lassandro G, Tiralongo F, et al. CTA imaging of peripheral arterial injuries. Diagnostics (Basel). 2024;14(13):1356. doi:10.3390/diagnostics14131356
  28. Gallo LK, Ramos CR, Rajani RR, Benarroch-Gampel J. Management and outcomes after upper versus lower extremity vascular trauma. Ann Vasc Surg. 2021;76:152-158. doi:10.1016/j.avsg.2021.05.007
  29. Stefanou N, Mylonas T, Angelis FA, Arnaoutoglou C, Varitimidis SE, Dailiana ZH. Upper extremity vascular injuries: etiology, management and outcome. World J Crit Care Med. 2024;13(2):91558. doi:10.5492/wjccm.v13.i2.91558