The role of CT angiography in military trauma

AimTo review whole-body computed tomography (CT) angiography as an unmatched way of fully assessing battle-injured patients, and the prevalence of vascular, predominantly arterial, injuries identified.Materials and methodsA retrospective analysis of 144 patients who underwent whole-body CT angiography in March 2011 was made. A vascular radiologist reviewed all images and imaging reports. Data gathered included positive findings from CT, anatomical region injured, mechanism of injury, time to CT, and the number of casualties per incident.ResultsOne hundred and forty-four patients underwent whole-body CT of which 17% had an occult vascular injury on CT. Twenty of these injuries (56%) were in the lower limbs, excluding extravasation at the site of amputation. Improvised explosive devices (IEDs) accounted for 71% (180 of 253) of battle injuries. The median time from admission to CT was 28 min. An additional 12% longer per patient is taken on average in a multiple casualty incident. Including contrast medium administration, whole-body angiography is completed in less than 2 min (mean 116 s).ConclusionA significant proportion of occult vascular injuries occur in penetrating fragmentation and blast injuries in military trauma. A low threshold for single-pass whole-body CT angiography is therefore justified.