The epidemiology and outcomes of vascular trauma in Gold Coast, Australia: Institutional experience at a level 1 trauma centre

Abstract

Background: Vascular trauma is a complex and evolving area. Unlike internationally, the epidemiology of vascular trauma is not well documented in Australia; the most recent study was published in 2013. Gold Coast University Hospital (GCUH) is a level 1 trauma centre in Queensland, Australia. The aim of this study was to describe the epidemiology and outcomes of vascular trauma at a level 1 trauma centre, and compare these with the Australian and international literature. Methods: All individuals who presented to GCUH between January 2014 and December 2019 with vascular injury were retrieved from the GCUH prospective trauma database. A descriptive analysis was undertaken on this cohort. Results: The incidence of vascular trauma as a percentage of total trauma remained stable over the study period. The study included 5454 trauma admissions to GCUH, of which 213 sustained vascular injuries. Males were more likely to be injured and blunt trauma was more common than penetrating. Blunt trauma was associated with increased injury complexity. The mortality rate was 8.5% and 10 patients required amputation. Conclusions: The proportion of vascular injuries as a percentage of total trauma in Australia is higher than in previous studies. Vascular trauma causes significant injuries and has a higher mortality rate than general trauma.

Civilian vascular trauma, treatment and outcome at a level 1-trauma centre

“…Injury scores in our study were significant higher for blunt vs. penetrating injury; but 67% of the blunt vascular trauma suffered polytrauma and often were in hypovolemic shock when admitted; a finding that is in line with other similar studies [ 5 , 20 ]. Still, no significant differences were identified for LOS or need for blood transfusion in the two groups groups; possibly due to insufficient power (type II error).…”

“…As the actual incidence of vascular trauma in most European countries is still unknown, [ 14 ] hopefully this study might shed some more light upon this issue. Our incidence figures are in line with those from Canada and Australia where 63–68% of vascular trauma is due to blunt force trauma [ 19 , 20 ], whereas in Finland, Sweden, United States and United Kingdom blunt trauma is reported to be the cause of vascular trauma in 38–48% of the cases [ 21 – 23 ]. Blunt trauma following a motor vehicle accident represented 46% of our vascular trauma cases.…”

“…The current study highlights the high morbidity and mortality associated with vascular trauma. In-hospital mortality was 29%, which is higher than observed mortality in other major trauma centres that have reported figures in the 5–23% range [ 5 , 20 , 22 , 30 ]. This difference between these studies could to some extent be explained by the fact that in our hospital patients with less severe vascular trauma are not defined as polytrauma patients and thus not evaluated by the trauma team—and therefore not included in the present study.…”

“…Still, no significant differences were identified for LOS or need for blood transfusion in the two groups groups; possibly due to insufficient power (type II error). A vascular trauma following blunt trauma as compared to penetrating injury, is a marker of significant transmission of force and therefore often substantially more severe injury with more extensive damage to associated soft tissue, bones, and nerves [ 5 , 20 , 28 , 29 ].…”

“…The median ISS and NISS values of the 68 patients who were admitted were 22 (14-36) and 33 (17-46), respectively; with 50 (74%) and 55 (81%) of the patients with ISS and NISS scores above 15; indicating severe injury. ISS and NISS scores were significant higher for blunt trauma, or 32 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) compared to 34 for penetrating trauma 14 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17) and 17 (10-27) (p < 0.05). The median estimated TRISS was 91%, or 93% vs. 90% (p = 0.90) for penetrating vs. blunt trauma; respectively.…”