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Vascular Trauma Patterns and Mortality at an Urban Trauma Center
Karan Garg, MD, Shang A. Loh, MD, Mathew S. Lopes, BS, Firas F. Mussa, MD, Glenn R. Jacobowitz, MD, Mark A. Adelman, MD, H Leon Pachter, MD, Caron B. Rockman, MD.
NYU Langone Medical Center, New York, NY, USA.
Background: Vascular trauma varies greatly from urban, to rural, to combat locations. The pattern and mortality of vascular injuries presenting to urban level I trauma centers has not been well described. This study seeks to 1) characterize the patterns and management of vascular injuries seen in an urban setting and 2) analyze characteristics, mortality, and scoring system utility based on anatomic regions of injury.
Methods: A retrospective review of the trauma database from January 2005 to September 2009 identified 108 patients with 143 non-intracranial vascular injuries. Demographics, injury and treatment characteristics, calculated trauma scores, and mortality of the group, as a whole and by anatomic region, were analyzed. Predicted mortality based on trauma scores was compared against actual mortality by anatomic regions.
Results: The mean age was 37.8 years with the majority of patients in the 26-50 year quartile. Patients were overwhelmingly male with the top three mechanisms being stabbing, pedestrian stuck, and gunshot resulting in predominately vessel lacerations or transections. Overall, the mean Injury Severity Score (ISS), APACHE II, Revised Trauma Score (RTS), and Trauma Injury Severity Score (TRISS) scores were 21.7±13.5, 11.2±9.3, 6.81±1.9, and .80±.30 with predicted mortalities of 10.2%, 13.3%, 4.05%, and 20.1%. The actual mortality was 21.3%. Over half of the vascular injuries were diagnosed clinically with 70% of the operative repairs performed open. Over 68% of the injuries were in the abdomen, pelvis, or lower extremity. The highest mortality occurred in vascular injuries to the head and neck (33.3%), abdomen (33.3%), pelvis (29.4%), and chest (27.3%). Use of endovascular treatments was highest in the pelvis (78.6%) and chest (50%). Only the TRISS was reasonably accurate in predicting the mortality for all anatomic regions.
Conclusions: Urban vascular trauma patterns represent a mix of blunt and penetrating trauma with high overall mortality. Endovascular repairs are still not commonly performed with the exception of stent-grafts in the thoracic aorta and embolizations in the pelvis. Trauma scoring systems fail to recognize the severity of abdominal vascular injuries; however, overall, the TRISS was reasonably accurate in predicting mortality.
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