Vascular injury-related in-hospital mortality in Ontario between 1991 and 2009

Altoijry, Abdulmajeed; Lindsay, Thomas F.; Johnston, K.Wayne; Mamdani, Muhammad; Al‐Omran, Mohammed

doi:10.1177/0300060520987728

Cited by 3 publications

(2 citation statements)

References 39 publications

(51 reference statements)

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“…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.…”

Section: Discussionmentioning

confidence: 55%

“…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.…”

Section: Severity Of Injurymentioning

confidence: 93%

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

Geisner

Gubberud

Guðbjartsson

2022

Scand J Trauma Resusc Emerg Med

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Background Outcomes after vascular injuries in wartime are well documented, but studies on vascular injuries in a civilian European populations are scarce. Methods A retrospective study on all adults admitted to a North-European level 1-trauma centre 2009–2018 with The Abbreviated Injury Scale-codes for non-iatrogenic vascular trauma (VT). Data were extracted from both national and regional trauma-registries, as well as patient charts. Patient demographics, mechanism, and location of vascular injury were registered as well as its treatment. Incidence and injury scores (ISS, NISS and TRISS) were calculated and overall survival (Kaplan–Meier) estimated. Results Of 4042 trauma-patients, 68 (1.7%) (median age 44 years, 76% males) sustained 81 vascular injuries (69 arterial; 12 venous); 46 blunt and 22 (32%) penetrating injuries. The total incidence of vascular injuries was 1.45/100,000 inhabitants and did not change over the study-period (95% confidence interval 1.13–1.82). The injuries were located in thorax (n = 17), neck (n = 16) and abdominal region (n = 15); most of the blunt injuries followed traffic (n = 31) or falling accidents (n = 10), and with 17 of the 22 penetrating injuries due to stabbing. The median ISS and NISS-scores were 22 and 33, with 50 (74%) and 55 (81%) patients having scores > 15, respectively. Forty-three (63%) patients had open surgical repair and 8 (12%) received endovascular treatment. Twenty-one patients died within 30-days (31%), 33% and 27% after blunt and penetrating injuries, respectively. Half of the patients that died within 24 h sustained aortic injury. Conclusions Traumatic vascular injuries are rare in civilian settings and are less than 2% of major trauma admissions. These patients are often seriously injured and their treatment can be challenging with high 30-day mortality. Trial registration: Retrospectively registered.

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Section: Discussionmentioning

confidence: 55%

Section: Severity Of Injurymentioning

confidence: 93%

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

Geisner

Gubberud

Guðbjartsson

2022

Scand J Trauma Resusc Emerg Med

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Abdominal Vascular Trauma

Hwang

Santorelli

Kobayashi

et al. 2023

Textbook of Emergency General Surgery

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Abdominal vascular trauma, primarily due to penetrating mechanisms, is uncommon. However, when it does occur, it can be quite lethal, with mortality ranging from 20% to 60%. Increased early mortality has been associated with shock, acidosis, hypothermia, coagulopathy, free intraperitoneal bleeding and advanced American Association for the Surgery of Trauma Organ Injury Scale grade. These patients often arrive at medical centers in extremis and require rapid surgical control of bleeding and aggressive resuscitation including massive transfusion protocols. The most important factor in survival is surgical control of hemorrhage and restoration of appropriate perfusion to the abdominal contents and lower extremities. These surgical approaches and the techniques of definitive vascular repair can be quite challenging, particularly to the inexperienced surgeon. This review hopes to describe the most common abdominal vascular injuries, their presentation, outcomes, and surgical techniques to control and repair such injuries.

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