GCS as a predictor of mortality in patients with traumatic inferior vena cava injuries: a retrospective review of 16 cases

Abstract

IntroductionRecent research has determined Glasgow Coma Scale (GCS) to be an independent predictor of mortality in patients with traumatic inferior vena cava (IVC) injuries. The aim of this study was to evaluate the use of GCS, as well as other factors previously described as determinants of mortality, in a cohort of patients presenting with traumatic IVC lesions.MethodsA 7-year retrospective review was undertaken of all trauma patients presenting to a tertiary care trauma center with trauma related IVC lesions. Factors described in the literature as associated with mortality were assessed with univariate analysis. ANOVA analysis of variance was used to compare means for continuous variables; dichotomous variables were assessed with Fischer’s exact test. Logistic regression was performed on significant variables to assess determinants of mortality.ResultsSixteen patients with traumatic IVC injuries were identified, from January 2005 to December 2011. Six patients died (mortality, 37.5%); the mechanism of injury was blunt in one case (6.2%) and penetrating in the 15 others (93.7%). Seven patients underwent thoracotomy in the operating room (OR) to obtain vascular control (43.7%). Upon univariate analysis, non-survivors were significantly more likely than survivors to have lower mean arterial pressures (MAP) in the emergency room (ER) (45.6 +/- 8.6 vs. 76.5 +/- 25.4, p = 0.013), a lower GCS (8.1 +/- 4.1 vs. 14 +/- 2.8, p = 0.004), more severe injuries (ISS 60.3 +/- 3.5 vs 28.7 +/- 22.9, p = 0.0006), have undergone thoracotomy (83.3% vs. 16.6%, p = 0.024), and have a shorter operative time (105 +/- 59.8 min vs 189 +/- 65.3 min, p = 0.022). Logistic regression analysis revealed GCS as a significant inverse determinant of mortality (OR = 0.6, 0.46-0.95, p = 0.026). Other determinants of mortality by logistic regression were thoracotomy (OR = 20, 1.4-282.4, p = 0.027), and caval ligation as operative management (OR = 45, 2.28-885.6, p = 0.012).ConclusionsGCS, the need to undergo thoracotomy, and caval ligation as operative management are significant predictors of mortality in patients with traumatic IVC injuries.

Plain and Contrast Enhanced CT Imaging Findings of a Rare Case of IVC Pseudoaneurysm

“…Traumatic inferior vena cava (IVC) lesions represent 30% to 40% of trauma related abdominal vascular injuries [1]. IVC aneurysms are rare clinical entity, are always acquired [2].…”

“…Presenting symptoms include abdominal pain, IVC syndrome, tachycardia, upper gastrointestinal bleeding secondary to venobiliary fistulas, hemorrhagic shock secondary to rupture, and pulmonary embolus or other thromboembolic phenomenon. An overall mortality rate for IVC trauma is 40% [1]. Predictors of mortality are 1) hemodynamic condition of the patient on arrival and 2) the location of the Open Journal of Internal Medicine caval lesion [1] [2], associated injuries, preoperative lactate and base deficits, ISS and GCS [1].…”

“…An overall mortality rate for IVC trauma is 40% [1]. Predictors of mortality are 1) hemodynamic condition of the patient on arrival and 2) the location of the Open Journal of Internal Medicine caval lesion [1] [2], associated injuries, preoperative lactate and base deficits, ISS and GCS [1]. Injury to suprarenal (infrahepatic) and retrohepatic segments is associated with high mortality rate, whereas injury to infrarenal segment is associated with lowest mortality rate.…”

“…Blunt injury to the inferior vena cava is rare, ascribable for approximately 30% -40% of abdominal vascular injuries [1]. Sudden deceleration causes shear forces on vessels.…”

Preditores independentes de mortalidade em pacientes politraumatizados: estudo longitudinal, prospectivo, observacional

“…Há ainda a vertente de pesquisa que traz à tona a questão dos índices de trauma, com a tentativa de validar novos parâmetros para predição de morbimortalidade (18,(86)(87)(88)(89)(90)(91)(92)(93)(94). No entanto, há estudos retrospectivos(6), que publicaram conclusões não balizadas pelo desenho original (18) Continua atropelamento por trem; autoxaf = colisão auto versus anteparo fixo; autoxauto = colisão auto versus auto; autoc = colisão auto versus caminhão; espanc = espancamento; fab = ferimento por arma branca; faf = ferimento por arma de fogo; MotaA -colisão frontal auto versus moto; motoXa = colisão lateral moto versus auto; motoaf = colisão moto versus anteparo fixo; motoxauto = colisão lateral moto versus auto; motoxbike = colisão moto versus bicicleta; motoXC = colisão moto versus caminhão; motoXo = colisão moto versus ônibus; mXa = colisão lateral moto versus auto; mXc = colisão lateral moto versus caminhão; oXc = colisão ônibus versus caminhão; queda = queda de altura; queda/AtropA = queda de moto seguida por atropelamento por auto; quedaM = queda de moto; quedaMAtropO = queda de moto seguida por atropelamento por ônibus; soterram = soterramento.…”