• Leily Naraghi, Andreas Larentzakis, Yuchiao Chang, Anne-Christine Duhaime, Haytham Kaafarani, Daniel D Yeh, David R King, Marc A de Moya, and George C Velmahos.
• Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
• J. Am. Coll. Surg.. 2015 Jun 1;220(6):1027-31.

BackgroundComputed tomography angiography (CTA) has been increasingly used in traumatic brain injury (TBI) patients to uncover vascular lesions that might have preceded the trauma and caused the bleed. This study aims to evaluate the usefulness of head CTA in the initial care of blunt TBI patients.Study DesignWe conducted a retrospective case-control analysis of adult TBI patients, admitted to our Level I trauma center from January 1, 2012 to December 31, 2012. The patients were grouped as those with and without a CTA of the head. The primary outcomes included a change in management after the findings of head CTA and secondary outcomes included rate of admission to the ICU, ICU length of stay, hospital length of stay, discharge disposition, and mortality.ResultsSix hundred adult patients had blunt TBI and underwent head CT as a part of their evaluation. Of these 600 patients, 132 (22%) underwent head CTA in addition to CT. Only one patient had altered management after the CTA results; the patient had a diagnostic angiogram that was negative. Ninety-eight patients did not have any additional findings on CTA. Of the remaining 33 patients with additional CTA findings, 12 had incidental vascular malformations, which showed no acute pathology and were not related to the injury. In the matched comparisons, patients with CTA had a longer hospital stay, higher rate of ICU admission, and longer ICU stay. There was no significant difference in mortality and discharge disposition between the 2 groups.ConclusionsHead CTA is commonly used after blunt TBI but does not alter management and should be abandoned in the absence of clear indications.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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