{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T01:39:09Z","timestamp":1793497149820,"version":"4.5.0"},"reference-count":23,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can Assoc Radiol J"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>\n                    <jats:bold>Introduction:<\/jats:bold>\n                    Computed tomography angiography (CTA) plays an important role in assessing patients with suspected lower extremity traumatic vascular injury. However, CTA overutilization has been reported in some centres, and improper use has been linked to increased healthcare costs and prolonged Emergency Department wait times. This study evaluated CTA utilization in a Canadian Level I trauma centre, determined the rate of positive CTA studies requiring intervention, and identified factors that may reduce unnecessary examinations.\n                    <jats:bold>Methods and Materials:<\/jats:bold>\n                    This retrospective study included trauma patients who underwent lower extremity CTA between January 2020 and September 2024. Data regarding patient demographics, mechanism of injury, physical exam and computed tomography findings, ankle-brachial index value, and interventions were collected and evaluated. Statistical analysis included descriptive statistics and chi-square or Fisher\u2019s exact tests for categorical associations.\n                    <jats:bold>Results:<\/jats:bold>\n                    Six hundred twelve patients (82% male, median age 32 years) were included. Forty-six percent had a normal physical exam, and CTA was positive in 27% of cases. Eight percent of patients required an intervention, all of whom had at least one hard sign of vascular injury. A statistically significant association was identified between hard signs of a vascular injury and positive CTA findings (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; .001) and major vascular injuries (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; .01). No patients with a normal physical exam and a positive CTA required intervention.\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Nearly half of the CTA studies were performed on patients with a normal physical exam, none requiring intervention. Our findings suggest that implementing institution-specific appropriate criteria may reduce unnecessary CTA studies.\n                  <\/jats:p>","DOI":"10.1177\/08465371251342064","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T02:47:46Z","timestamp":1748314066000},"page":"187-194","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Computed Tomography Angiography Utilization in Lower Extremity Trauma: Insights From a Canadian Level I Trauma Centre"],"prefix":"10.1177","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6399-3113","authenticated-orcid":false,"given":"Jacques","family":"du Plessis","sequence":"first","affiliation":[{"name":"Emergency and Trauma Radiology Division, Department of Medical Imaging, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada"},{"name":"Emergency Radiology Division, Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0504-7973","authenticated-orcid":false,"given":"Amos","family":"Kalu","sequence":"additional","affiliation":[{"name":"Sunnybrook Research Institute, Sunnybrook Health Science Centre, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7141-1331","authenticated-orcid":false,"given":"Hayley","family":"McKee","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1264-685X","authenticated-orcid":false,"given":"Abdelazim","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Radiology Department, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rayane","family":"Maroun","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Lebanese American University, Beirut, Beirut Governorate, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3696-2554","authenticated-orcid":false,"given":"Ferco H.","family":"Berger","sequence":"additional","affiliation":[{"name":"Emergency and Trauma Radiology Division, Department of Medical Imaging, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada"},{"name":"Emergency Radiology Division, Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada"},{"name":"Tory Trauma Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7045-1534","authenticated-orcid":false,"given":"Gilbert","family":"Maroun","sequence":"additional","affiliation":[{"name":"Vascular and Interventional Radiology, Department of Medical Imaging, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, 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