Utility of ABI and API Versus CTA to Identify Surgically Significant Arterial Injury After Lower Extremity Trauma in a LMIC Article Swipe
Rubinette Robbertze
,
Megan Lubout
,
Daniel Nicholas Prince
,
Ilse Joubert
,
Maeyane Stephens Moeng
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1002/wjs.12623
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1002/wjs.12623
Background South Africa faces a high burden of trauma‐related vascular injury. Prompt diagnosis and management are crucial to limit morbidity and mortality. Literature recommends a thorough vascular examination of at‐risk patients. Ankle brachial index (ABI) and arterial pressure index (API) are considered reliable screening tools for lower extremity vascular injury (LEVI) in the correct clinical scenario. Patients with an abnormal ABI/API warrant diagnostic imaging with computed tomography angiography (CTA). However, recent international literature demonstrates a trend toward potential CTA overuse in the work up for LEVI, when the internationally recommended vascular injury work‐up guidelines are not followed correctly. Aim To assess the reliability of ABI/API in trauma patients with suspected LEVI as a screening tool to safely avoid unnecessary CTA. Methods A retrospective cohort study of all lower extremity trauma patients with soft signs of LEVI who presented to Charlotte Maxeke Johannesburg Academic Hospital from February 1, 2018 to January 31, 2020 was undertaken. Sensitivity, specificity, NPV, and PPV were calculated for ABI/API versus CTA and ABI/API/CTA versus surgically significant arterial injury. A p ‐value < 0.05 indicated statistical significance (confidence level = 95%). Results Four hundred and thirty‐three CTAs were performed for suspected traumatic LEVI. Two hundred and eighty‐two were excluded due to missing data (precluding retrospective calculation of ABI/API) and 151 patients were included. To detect surgically significant injury, CTA had a 100% sensitivity, 97.2% specificity, 100% NPV, and 69.2% PPV; ABI and API had a 100% sensitivity, 83.8%–85.9% specificity, 100% NPV, and 28.1%–35.9% PPV, respectively. Neither ABI nor API missed surgically significant arterial injuries. Conclusion This affirms the reliability of ABI/API as a screening tool to identify patients at risk of LEVI from penetrating trauma. Findings supported international data demonstrating CTA overuse in this subset of patients.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1002/wjs.12623
- https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/wjs.12623
- OA Status
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- References
- 13
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4410500185
All OpenAlex metadata
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https://openalex.org/W4410500185Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1002/wjs.12623Digital Object Identifier
- Title
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Utility of ABI and API Versus CTA to Identify Surgically Significant Arterial Injury After Lower Extremity Trauma in a LMICWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
-
2025Year of publication
- Publication date
-
2025-05-19Full publication date if available
- Authors
-
Rubinette Robbertze, Megan Lubout, Daniel Nicholas Prince, Ilse Joubert, Maeyane Stephens MoengList of authors in order
- Landing page
-
https://doi.org/10.1002/wjs.12623Publisher landing page
- PDF URL
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/wjs.12623Direct link to full text PDF
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YesWhether a free full text is available
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hybridOpen access status per OpenAlex
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/wjs.12623Direct OA link when available
- Concepts
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Medicine, Vascular surgery, Retrospective cohort study, Computed tomography angiography, Confidence interval, Radiology, Angiography, Work-up, Injury Severity Score, Surgery, Cardiac surgery, Internal medicine, Emergency medicine, Poison control, Injury preventionTop concepts (fields/topics) attached by OpenAlex
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0Total citation count in OpenAlex
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.reliable | 43 |
| abstract_inverted_index.thorough | 26 |
| abstract_inverted_index.vascular | 10, 27, 49, 91 |
| abstract_inverted_index.‐value | 175 |
| abstract_inverted_index.Charlotte | 140 |
| abstract_inverted_index.at‐risk | 30 |
| abstract_inverted_index.diagnosis | 13 |
| abstract_inverted_index.extremity | 48, 129 |
| abstract_inverted_index.included. | 216 |
| abstract_inverted_index.indicated | 178 |
| abstract_inverted_index.injuries. | 257 |
| abstract_inverted_index.morbidity | 20 |
| abstract_inverted_index.patients. | 31, 290 |
| abstract_inverted_index.performed | 192 |
| abstract_inverted_index.potential | 78 |
| abstract_inverted_index.presented | 138 |
| abstract_inverted_index.scenario. | 56 |
| abstract_inverted_index.screening | 44, 114, 267 |
| abstract_inverted_index.supported | 280 |
| abstract_inverted_index.suspected | 110, 194 |
| abstract_inverted_index.traumatic | 195 |
| abstract_inverted_index.work‐up | 93 |
| abstract_inverted_index.Background | 1 |
| abstract_inverted_index.Conclusion | 258 |
| abstract_inverted_index.Literature | 23 |
| abstract_inverted_index.calculated | 161 |
| abstract_inverted_index.considered | 42 |
| abstract_inverted_index.correctly. | 98 |
| abstract_inverted_index.diagnostic | 63 |
| abstract_inverted_index.guidelines | 94 |
| abstract_inverted_index.literature | 73 |
| abstract_inverted_index.management | 15 |
| abstract_inverted_index.mortality. | 22 |
| abstract_inverted_index.recommends | 24 |
| abstract_inverted_index.surgically | 169, 219, 254 |
| abstract_inverted_index.tomography | 67 |
| abstract_inverted_index.(confidence | 181 |
| abstract_inverted_index.(precluding | 207 |
| abstract_inverted_index.ABI/API/CTA | 167 |
| abstract_inverted_index.angiography | 68 |
| abstract_inverted_index.calculation | 209 |
| abstract_inverted_index.examination | 28 |
| abstract_inverted_index.penetrating | 277 |
| abstract_inverted_index.recommended | 90 |
| abstract_inverted_index.reliability | 103, 262 |
| abstract_inverted_index.significant | 170, 220, 255 |
| abstract_inverted_index.statistical | 179 |
| abstract_inverted_index.undertaken. | 154 |
| abstract_inverted_index.unnecessary | 119 |
| abstract_inverted_index.Johannesburg | 142 |
| abstract_inverted_index.Sensitivity, | 155 |
| abstract_inverted_index.demonstrates | 74 |
| abstract_inverted_index.eighty‐two | 200 |
| abstract_inverted_index.sensitivity, | 226, 240 |
| abstract_inverted_index.significance | 180 |
| abstract_inverted_index.specificity, | 156, 228, 242 |
| abstract_inverted_index.28.1%–35.9% | 246 |
| abstract_inverted_index.83.8%–85.9% | 241 |
| abstract_inverted_index.demonstrating | 283 |
| abstract_inverted_index.international | 72, 281 |
| abstract_inverted_index.respectively. | 248 |
| abstract_inverted_index.retrospective | 123, 208 |
| abstract_inverted_index.thirty‐three | 189 |
| abstract_inverted_index.internationally | 89 |
| abstract_inverted_index.trauma‐related | 9 |
| cited_by_percentile_year | |
| countries_distinct_count | 3 |
| institutions_distinct_count | 5 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.8100000023841858 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.27816101 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |