Ahead of Print: CTA Negative SAH: Cost-effectiveness

Background: Recent studies have documented the high sensitivity of CT angiography (CTA) in detecting a ruptured aneurysm in the presence of acute subarachnoid hemorrhage (SAH). The practice of digital subtraction angiography (DSA) when CTA does not reveal an aneurysm has thus been called into question.

Objective: We examined this dilemma from a cost-effectiveness perspective using current decision analysis techniques.

Methods: A decision tree was created using TreeAge Pro Suite 2012; in one arm a CTA negative SAH was followed-up with DSA, in the other patients were observed without further imaging. Based on literature review, costs and utilities were assigned to each potential outcome. Base case and sensitivity analysis were performed to determine the cost-effectiveness of each strategy. A Monte Carlo simulation was then conducted, by sampling each variable over a plausible distribution, to evaluate the robustness of the model.

Ahead of Print: Diagnostic Yield of Repeat Catheter Angiography in Patients with Catheter and CT Angiography Negative Subarachnoid Hemorrhage

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BACKGROUND: The yield of repeat catheter angiography in patients with subarachnoid hemorrhage (SAH) who have negative initial catheter and CT angiograms is not well understood.

OBJECTIVE: To determine the yield of repeat catheter angiography in a prospective cohort of patients with SAH and negative initial catheter and CT angiograms.

METHODS: From January 1st, 2005, until September 1st, 2010, we instituted a prospective protocol in which patients with SAH documented by non-contrast CT (NCCT) or cerebrospinal fluid (CSF) xanthochromia and negative initial catheter and CT angiograms were evaluated with repeat catheter angiography 7 days and 3 months after presentation to assess for causative vascular abnormalities.

Ahead of Print: Incidence of Blunt Craniocervical Artery Injuries: Use of Whole Body CT Trauma Imaging with Adapted CT Angiography

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BACKGROUND: The incidence of traumatic craniocervical artery dissection varies in published trauma series.

OBJECTIVE: To determine the frequency of traumatic craniocervical artery injury in polytrauma patients by using a standardized whole body trauma computed tomography (WBCT) with an adapted CT angiography (CTA) of the craniocervical vessels.

METHODS: 718 consecutive patients requiring a whole body trauma CT (16-row-multi-slice) due to the mechanism of their injury patterns and an Injury Severity Sale of greater than 16 were analyzed prospectively. After cranial scan, the CT angiography of the craniocervical vessels with 40 ml of iodinated contrast agent was performed using bolus tracking.