BACKGROUND AND PURPOSE: Evaluation for blunt @entity130 has generated immense controversy with wide variations in recommendations regarding the need for evaluation and the optimal imaging technique. We review the literature and determine the most cost-effective strategy for evaluating blunt @entity130 in @entity130 @entity1 . MATERIALS AND METHODS: A comprehensive literature review was performed with data extracted to create a decision-tree analysis for 5 different strategies: anticoagulation for high-risk (based on the Denver screening criteria) @entity1 , selective DSA or CTA (only high-risk @entity1 ), and DSA or CTA for all @entity130 @entity1 . The economic evaluation was based on a health care payer perspective during a 1-year horizon. Statistical analyses were performed. The cost-effectiveness was compared through 2 main indicators: the incremental cost-effectiveness ratio and net monetary benefit. RESULTS: Selective anticoagulation in high-risk @entity1 was shown to be the most cost-effective strategy, with the lowest cost and greatest effectiveness (an average cost of  21.08 and average quality-adjusted life year of 0.7231). Selective CTA has comparable utility and only a slightly higher cost (an average cost of  48.84 and average quality-adjusted life year of 0.7229). DSA, whether performed selectively or for all @entity1 , was not optimal from both the cost and utility perspectives. Sensitivity analyses demonstrated these results to be robust for a wide range of parameter values. CONCLUSIONS: Selective CTA in high-risk @entity1 is the optimal and cost-effective imaging strategy. It remains the dominant strategy over DSA, even assuming a low CTA sensitivity and irrespective of the proportion of @entity1 at high-risk and the incidence of blunt @entity130 in high-risk @entity1 .

Evaluation for Blunt XXXX : Review of the Literature and a Cost-Effectiveness Analysis.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity130 :: ('MESH:D014947', 'Disease') :: ['trauma', 'cerebrovascular injury']
@entity130 :: (MESH:D014947,Disease) :: ['Cerebrovascular Injury']
