Incidental findings on head and neck CTA obtained for evaluation of patients with traumatic injuries

Introduction Approximately 1% to 3% of blunt trauma patients experience blunt cerebrovascular injury (BCVI), which may lead to thromboembolic stroke if not addressed. While clinical screening criteria for BCVI exist (e.g. Denver, Memphis), some injuries are not promptly recognized. To better detect BCVIs, some institutions have begun performing head and neck computed tomography angiography (CTA) on all patients following serious blunt traumatic injury. The expanded use has led to a corresponding increase in incidental findings (IFs), some of which merit further scrutiny. The authors’ institution adopted a policy of universal head and neck CTA screening for all serious blunt trauma patients in February 2023. This study explores frequencies of BCVIs and IFs and assesses whether patients with IFs undergo further evaluation and/or treatment. Methods A retrospective review was performed of Epic medical records of patients treated at the authors’ institution for a blunt traumatic injury who underwent head and neck CTA between 3 January 2023 and 29 February 2024. Results A total of 45 BCVIs were detected among 33 of the 535 patients (6.2%). The majority (81.8% [27/33]) of patients were treated with ambulatory antithrombotic therapy. Two patients experienced strokes during hospitalization. Of patients with BCVIs, 1 met only Memphis criteria (3.0%), 15 met only expanded Denver criteria (45.5%), 12 met both Memphis and Expanded Denver criteria (36.4%); 5 met neither set (15.2%). A total of 122 patients (22.8%) had IFs on head and neck CTA. Twenty-eight (21.9%) had follow-up recommended, and seven (5.5%) pursued follow-up. Of those treated for IFs, four (3.1%) received medication, and one (0.8%) underwent a surgical procedure. Conclusions Application of universal head and neck CTA screening aided in the timely detection of BCVIs among serious blunt trauma patients. IFs were not uncommon with this imaging method; some were considered medically relevant and subsequently monitored and/or treated accordingly.