COMPUTED-TOMOGRAPHY AS A SCREENING EXAM IN PATIENTS WITH SUSPECTED BLUNT AORTIC INJURY

Background Chest computed tomography (CT) screening of patients with b lunt trauma for thoracic aortic injury is controversial. This study wa s undertaken to determine whether CT could exclude aortic injury and b e used to select patients for aortography. Methods Computed tomography and aortography were used to evaluate 155 patients with blunt trauma. Computed tomography scans were reviewed separately by four attending radiologists who were unaware of the patients' clinical course and ang iographic findings. Results Eight of 155 patients had aortic injuries requiring operation. Computed tomography scans in five patients were r ead Eis positive by all reviewers. One scan was read as positive by th ree reviewers and as negative by one. Two scans were read as positive by two radiologists and as negative by two. After poor scans were excl uded, the combined sensitivity of CT for detecting aortic injury was 8 8%, specificity was 54%, positive predictive value was 9%, and negativ e predictive value 99%. Conclusions The sensitivity of CT scan for ind icating the need for aortography is observer dependent. As CT manifest ations of aortic injury are often subtle, CT does not reliably exclude aortic injury.