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Is Computed Tomographic Angiography of the Head Useful in the Management of Traumatic Brain Injury?
*Leily Naraghi, *Andreas Larentzakis, *Catrina M. Cropano, *Yuchiao Chang, *Laurie Petrovick, *Jarone Lee, *Daniel D. Yeh, *Haytham Kaafarani, *Peter J. Fagenholz, *Marc A. De Moya, *David R. King, George Velmahos
Massachusetts General Hospital, Boston, MA

1. OBJECTIVE
To evaluate the usefulness of computed tomographic angiography (CTA) of the head in the initial care of patients with blunt traumatic brain injury. Our hypothesis is that head CTA does not alter management in the acute care of TBI patients.
2. DESIGN
Retrospective case-control analysis of patients with (w-CTA) and without head CTA (wo-CTA).
3. SETTING
Level I trauma center in New England.
4. PATIENTS OR OTHER PARTICIPANTS
Adult patients with blunt TBI admitted from 01/01/2012 to 12/31/2012. Excluded were: a) Patients with histories of craniotomies and b) patients with previously diagnosed aneurysms.
5. INTERVENTION(S)
No.
6. MAIN OUTCOME MEASURE(S)
The primary outcome was any change in management, following the findings of the head CTA. Secondary outcomes included admission to intensive care unit (ICU), ICU stay, hospital stay, discharge disposition, and mortality.
7. RESULTS
Of 602 TBI patients 132 (22%) underwent head CTA in addition to the head CT. 34 (26%) patients had additional findings on CTA but no further action was required except of 1 patient who received a negative diagnostic angiogram. In the matched comparisons, w-CTA patients had longer hospital stay, higher rate of ICU admission, and longer ICU stay. There was no significant difference regarding mortality and discharge disposition among the two groups (Table).
8. CONCLUSIONS
Head CTA is commonly used after blunt TBI but does not alter management and should be abandoned in the absence of clear indications.
Comparison of characteristics and outcomes between w-CTA and wo-CTA groups.
w-CTA (n = 132)wo-CTA (n = 132)p value
Age, mean (SD), y56.6 (22.6)56.3 (21.7)0.52
AIS head & neck, Mean (SD)4.1 (0.7)4.1 (0.7)0.34
GCS on admission, Mean (SD)11.1 (5)10.9 (5)0.10
Hospital LOS, Mean (SD), days8 (10.1)12 (13)0.002
ICU admission (%)50640.008
ICU LOS, Mean (SD), days3.2 (6.5)4.4 (6.2)0.003
Final outcome0.75
Disposition to Home (%)4945.5
Disposition to Rehabilitation Facility (%)3742
Mortality (%)1412


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