Proximity Arteriography: Cost-effectiveness in Asymptomatic Penetrating Extremity Trauma

Keen, John D.; Dunne, Patrick; Keen, Richard R.; Langer, B

doi:10.1016/s1051-0443(07)61505-x

Cited by 21 publications

(9 citation statements)

References 52 publications

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“…The angiogram has been considered the gold standard, with a sensitivity of 99% and specificity of 97%, but is now rarely used in the evaluation of penetrating trauma without hard signs of vascular injury (19). This has occurred because up to 95% of these arteriograms were negative and management decisions changed in only 1.3% of patients with no clinical findings (7,20).…”

Section: Other Diagnostic Modalitiesmentioning

confidence: 99%

Penetrating Trauma to the Extremity

Manthey

Nicks

2008

The Journal of Emergency Medicine

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Section: Other Diagnostic Modalitiesmentioning

confidence: 99%

Penetrating Trauma to the Extremity

Manthey

Nicks

2008

The Journal of Emergency Medicine

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“…For example, in the diagnosis of arterial injury related to trauma to an extremity (Fig 3) the cost-effectiveness analyses considered in two studies (14,15) were observation, surgical exploration, and angiography. Unfortunately, the authors of neither study considered minimally invasive or noninvasive tests such as multidetector row CT angiography, MR angiography, or duplex US.…”

Section: Alternativesmentioning

confidence: 99%

Decision Making in the Face of Uncertainty and Resource Constraints: Examples from Trauma Imaging

Hunink¹

2005

Radiology

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The purpose of this review is to illustrate how tools and concepts from decision and cost-effectiveness analyses can be used to help make decisions in the face of uncertainty and resource constraints, select appropriate subjects for imaging, choose between competing imaging modalities, and prioritize future research. Examples from trauma imaging illustrate the use of the presented tools. The author advocates the PROACTIVE approach in deciding which imaging strategies are cost-effective (PRO for defining the problem, reframing the problem from multiple perspectives, and focusing on the objective; ACT for expanding the alternatives, considering the consequences and associated chances of each alternative, and identifying the trade-offs involved; IVE for integrating the evidence and values, optimizing the value of interest, and exploring uncertainty). Simulation models play an important role in the assessment of imaging strategies by helping to identify alternative strategies and to integrate the best-available evidence related to risks, benefits, patient values, and costs. Exploring the uncertainty in the evidence and assessing the value of obtaining more information can help prioritize future research and guide study design.

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“…[1,4] Although rapid detection, localization and specification of a vascular injury in these patients are essential for the effective management of PUET, it is ill-advised to perform diagnostic computed tomography angiography (CTA) or conventional angiography in every patient. [5][6][7] Over 90% of CTAs in these patients will be negative, representing a large cost as a screening tool. [7] ORIGINAL ARTICLE Ulus Travma Acil Cerrahi Derg, September 2013, Vol.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] Over 90% of CTAs in these patients will be negative, representing a large cost as a screening tool. [7] ORIGINAL ARTICLE Ulus Travma Acil Cerrahi Derg, September 2013, Vol. 19, No.…”

Section: Introductionmentioning

confidence: 99%

“…[6,[8][9][10] Hard signs of a vascular injury (Table 1) mandate emergent surgical exploration, or, when the patient is hemodynamically stable, endovascular treatment could be considered. [7,11] Diagnostic CTA is indicated in hemodynamically stable patients with clinical signs of vascular injury (Table 1). Similar to the case with penetrating trauma in other body regions, a selective non-operative management (SNOM) protocol should be used in PUET.…”

Section: Introductionmentioning

confidence: 99%

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