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

Burcu Özen Karabulut; Ali Ekber Karabulut; Cem Yıldırım; Ahmet Aykut

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

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.

Keywords

Supporting Institution

No financial support was received from any institution or organization for this study.

Project Number

Not applicable

Ethical Statement

This study was approved by the Non-Interventional Clinical Research Ethics Committee of the University of Health Sciences, Van Education and Research Hospital (Decision No: GOKAEK/2025-05-19; Date: July 4, 2025). The requirement for informed consent was waived due to the retrospective design of the study. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Thanks

The authors have no acknowledgments to declare.

References

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
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
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
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
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
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
Simsek Y, Gur A. Vascular injury of penetrating trauma of the extremities. Emerg Med Int. 2024;2024:9979585. doi:10.1155/emmi/9979585
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

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
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
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
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
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
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
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
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.
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
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
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
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
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
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
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
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
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
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
Tamburrini S, Lassandro G, Tiralongo F, et al. CTA imaging of peripheral arterial injuries. Diagnostics (Basel). 2024;14(13):1356. doi:10.3390/diagnostics14131356
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
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

Details

Primary Language

English

Subjects

Emergency Medicine

Journal Section

Research Article

Authors

Burcu Özen Karabulut
0000-0002-9046-6511
Türkiye

Ali Ekber Karabulut ^*
0000-0002-7203-1178
Türkiye

Cem Yıldırım
0009-0004-5359-6335
Türkiye

Ahmet Aykut
0009-0001-3173-8994
Türkiye

Publication Date

October 25, 2026

Submission Date

July 18, 2026

Acceptance Date

September 7, 2026

Published in Issue

Year 2026 Volume: 8 Number: 6

IZ

https://izlik.org/JA92NB72JN

Cite

RIS / Bibtex

APA

Özen Karabulut, B., 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, 8(6), 1247-1254. https://izlik.org/JA92NB72JN

AMA

1.Özen Karabulut B, Karabulut AE, Yıldırım C, Aykut A. Diagnostic yield of computed tomography angiography in traumatic extremity vascular injuries and clinical and laboratory predictors: a retrospective cohort study. Anatolian Curr Med J / ACMJ / acmj. 2026;8(6):1247-1254. https://izlik.org/JA92NB72JN

Chicago

Özen Karabulut, Burcu, Ali Ekber Karabulut, Cem Yıldırım, and Ahmet Aykut. 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 8 (6): 1247-54. https://izlik.org/JA92NB72JN.

EndNote

Özen Karabulut B, Karabulut AE, Yıldırım C, Aykut A (October 1, 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 8 6 1247–1254.

IEEE

[1]B. Özen Karabulut, A. E. Karabulut, C. Yıldırım, and A. Aykut, “Diagnostic yield of computed tomography angiography in traumatic extremity vascular injuries and clinical and laboratory predictors: a retrospective cohort study”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 6, pp. 1247–1254, Oct. 2026, [Online]. Available: https://izlik.org/JA92NB72JN

ISNAD

Özen Karabulut, Burcu - Karabulut, Ali Ekber - Yıldırım, Cem - Aykut, Ahmet. “Diagnostic Yield of Computed Tomography Angiography in Traumatic Extremity Vascular Injuries and Clinical and Laboratory Predictors: A Retrospective Cohort Study”. Anatolian Current Medical Journal 8/6 (October 1, 2026): 1247-1254. https://izlik.org/JA92NB72JN.

JAMA

1.Özen Karabulut B, Karabulut AE, Yıldırım C, Aykut A. Diagnostic yield of computed tomography angiography in traumatic extremity vascular injuries and clinical and laboratory predictors: a retrospective cohort study. Anatolian Curr Med J / ACMJ / acmj. 2026;8:1247–1254.

MLA

Özen Karabulut, Burcu, et al. “Diagnostic Yield of Computed Tomography Angiography in Traumatic Extremity Vascular Injuries and Clinical and Laboratory Predictors: A Retrospective Cohort Study”. Anatolian Current Medical Journal, vol. 8, no. 6, Oct. 2026, pp. 1247-54, https://izlik.org/JA92NB72JN.

Vancouver

1.Burcu Özen Karabulut, Ali Ekber Karabulut, Cem Yıldırım, Ahmet Aykut. Diagnostic yield of computed tomography angiography in traumatic extremity vascular injuries and clinical and laboratory predictors: a retrospective cohort study. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 Oct. 1;8(6):1247-54. Available from: https://izlik.org/JA92NB72JN