Value of computed tomographic angiography in neck and extremity pediatric vascular trauma

Purpose: We sought to define the sensitivity and specificity of computed tomographic angiography (CTA) in pediatric vascular injuries. Methods: All neck and extremity CTAs performed in pediatric patients at a level I trauma center were reviewed from 2001 to 2007. Results: Overall, 78 patients were identified with an average age of 15.0 +/- 4.0 (0-18 years). Males outnumbered females 3.6:1. CTA was performed for 41 penetrating and 37 blunt traumas. Most penetrating injuries were due to missile wounds (71%) or stab wounds (17%). Eleven major vascular injuries resulted from penetrating trauma. For penetrating trauma, CTA was 100% sensitive and 93% specific. CTA for penetrating trauma had a positive predictive value (PPV) of 85% and negative predictive value (NPV) of 100%. Most blunt injuries were due to motor vehicle accidents (57%), followed by pedestrian hit by car (27%). Eight major vascular injuries resulted from blunt trauma. For blunt trauma, CTA was 88% sensitive and 100% specific. CTA for blunt trauma had a PPV of 100% and an NPV of 97%. The accuracy for penetrating and blunt trauma was 95% and 97%, respectively. Conclusions: CTA is highly sensitive, specific, and accurate for pediatric neck and extremity vascular trauma. (C) 2009 Elsevier Inc. All rights reserved.