Predictors of Outcomes in 1,441 Vascular Injuries: 10-Year Experience in a Large Urban Trauma Center.

BACKGROUND

Few civilian epidemiological studies have been reported for vascular injuries. The aim is to describe epidemiology, survival stratified by mechanism of injury, specific vessel injuries, outcomes of emergency department resuscitative thoracotomy (EDT), and independent predictors of mortality for vascular injuries.

STUDY

DESIGN

Retrospective 10-year review of patients with vascular injuries. Interventions included EDT and operative repair. Stepwise logistic regression to identify independent risk factors as predictors of mortality. Adjusted odds ratios (AORs) and 95% CIs were calculated.

RESULTS

Of 966 patients admitted, 1,441 had vessel injuries and 329 (34%) succumbed. For penetrating injury, n = 854 (88%), and for blunt injury, n = 111 (12%). Mean systolic blood pressure was 93 ± 51, Revised Trauma Score was 6.0 ± 2.7, and Injury Severity Score was 22 ± 19.3; 122 patients (12.7%) underwent EDT, and 7 (6%) survived. Stepwise logistic regression analysis identified 14 independent predictors for mortality including cardiac injury (p < 0.001; AOR 14.4; 95% CI 1.6 to 134); EDT (p = 0.0032; AOR 9.8; 95% CI 2.2 to 44.7); splenic injury (p = 0.0085; AOR 9.1; 95% CI 1.8 to 47.0); Injury Severity Score greater than 15 (p < 0.0001; AOR 7.8; 95% CI 4.3 to 15.0); nonfemoral artery injury (p = 0.0003; AOR 7.5; 95% CI 2.8 to 25.5); Glasgow Coma Score less than 8 (p < 0.0001; AOR 7.2; 95% CI 4.0 to 13.4); IVC injury (p < 0.0001; AOR 5.7; 95% CI 2.8 to 11.6); skull fracture (p = 0.0322; AOR 5.5; 95% CI 1.2 to 134); abdominal aortic injury (p < 0.0001; AOR 5.4; 95% CI 2.3 to 12.5); iliac artery injury (p = 0.0019; AOR 3.1; 95% CI 1.5 to 6.3); thoracic aortic injury (p = 0.0206; AOR 3.1; 95% CI 1.2 to 7.9); superior mesenteric vein injury (p = 0.0166; AOR 2.8; 95% CI 1.2 to 6.6); systolic blood pressure less than 90 (p = 0.0051; AOR 2.0; 95% CI 1.2 to 3.3); and hepatic injury (p = 0.045; AOR 1.9; 95% CI 1.0 to 3.7). The stepwise logistic regression model had a MAX-rescaled R2 of 0.87 and a concordance level of 94%.

CONCLUSIONS

Vascular injuries with instability or injury to specific high-risk critical vessels incur high mortality. EDT has a low salvage rate. Predictive risk factors for mortality were identified.