Incidence and Characteristics of Vascular Trauma at a Level II Trauma Center in a Suburban Teaching Hospital
Alan M. Dietzek, MD, Einstein Juma, Syed Rizvi, Dahlia Plummer, Ian Schlieder, Rio Nomoto, David Mann, Emi Manuia, Minha Kim, Alexander Ostapenko, Shawn Liechty.
Danbury Hospital, Danbury, CT, USA.
OBJECTIVES Much of the literature describing vascular trauma has come from American College of Surgeons designated Level 1 trauma centers (L1TC). However, significant numbers of patients suffering trauma in the United States are often treated at , robust, Level II centers (L2TC). There is little published literature on the vascular trauma experience at a L2TC. We sought to characterize the indications for vascular surgery (VS) consultation as well as the incidence, type, and outcome of traumatic vascular injuries at a L2TC. METHODS A retrospective chart review was performed for all trauma patients seen at our L2TC between 2013-2018 for whom vascular surgery was consulted. The data collected focused on indications for consultation, types of vascular injuries and outcomes. The means and frequencies were utilized for descriptive purposes. RESULTS VS consultation was performed in 110 (3.6%) of the 3062 trauma patients evaluated at our L2TC. Of these, 22 (20%) were for IVC filter placement. Vascular intervention was required in 22 (25%) of the remaining 88 patients; lower extremity - 14 (64%), upper extremity - 3 (13.6%), neck - 2 (9.1%), chest - 2 (9.1%), pelvis - 1 (4.5%). , (34%) head/neck (30%), The mechanism of injury was blunt in 87.5% and penetrating in 12.5%. The mean age was 57.2 years, with a range of 22-94y and 68% of patients were male. The mean Injury Severity Score (ISS) was 12,(range of 5-54; SD+9.58). Overall mortality was 4.5% and was highest (7.6%) in patients who suffered head/neck trauma. Limb loss occurred in 7.1% and there were no strokes. Endovascular interventions were performed in 55% of all injuries and 100% of those associated with chest trauma. CONCLUSIONSReported mortality rates at L1TC exceed 20% in trauma patients with vascular injury. At our L2TC, the mortality was substantially lower as was the overall rate of vascular injury. Also, 80% of vascular consults did not indicate the need for reparative vascular intervention. This likely reflects the much higher incidence of penetrating and poly-trauma seen at L1TCs. Vascular injuries were more often managed by endovascular means in contradistinction to the more frequent use of open surgery in L1TCs. Finally, our study suggests that vascular surgeons are integral to L2TCs as well as L1TCs.
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