scholarly journals Prevalence and outcome of abdominal vascular injury in severe trauma patients based on a TraumaRegister DGU international registry analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mohammad Esmaeil Barbati ◽  
Frank Hildebrand ◽  
Hagen Andruszkow ◽  
Rolf Lefering ◽  
Michael J. Jacobs ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Vascular Injury ◽  
Arterial Injury ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Comparable Rate ◽  
Venous Injury ◽  
The Impact ◽  
Abdominal Vascular Injuries

AbstractThis study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma based on a large registry of trauma patients. The impact of arterial, venous and mixed vascular injuries on patients’ outcome was of interest, as in particular the relevance of venous vessel injury may be underestimated and not adequately assessed in literature so far. All patients of TraumaRegister DGU with the following criteria were included: online documentation of european trauma centers, age 16–85 years, presence of abdominal vascular injury and Abbreviated Injury Scale (AIS) ≥ 3. Patients were divided in three groups of: arterial injury only, venous injury only, mixed arterial and venous injuries. Reporting in this study adheres to the STROBE criteria. A total of 2949 patients were included. All types of abdominal vessel injuries were more prevalent in patients with abdominal trauma followed by thoracic trauma. Rate of patients with shock upon admission were the same in patients with arterial injury alone (n = 606, 33%) and venous injury alone (n = 95, 32%). Venous trauma showed higher odds ratio for in-hospital mortality (OR: 1.48; 95% CI 1.10–1.98, p = 0.010). Abdominal arterial and venous injury in patients suffering from severe trauma were associated with a comparable rate of hemodynamic instability at the time of admission. 24 h as well as in-hospital mortality rate were similar in in patients with venous injury and arterial injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible subtle venous injury.

scholarly journals Prevalence and Outcome of Abdominal Vascular Injury in Severe Trauma Patients – An International Registry Analysis

2021 ◽  
Author(s):  
Mohammad Esmaeil Barbati ◽  
Frank Hildebrand ◽  
Hagen Andruszkow ◽  
Rolf Lefering ◽  
Michael Jacobs ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Hemodynamic Instability ◽  
Arterial Injury ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Venous Injury ◽  
Arterial And Venous Injuries ◽  
Time Of Admission ◽  
Abdominal Vascular Injuries

Abstract BackgroundThis study details the etiology, frequency and effect of abdominal vascular injuries in patients after polytrauma.Patients and methodsAll patients of TraumaRegister DGU® with following criteria were included: online documentation of European trauma centers, age 16-85 years, presence of abdominal vascular injury, and AIS ≥ 3. Patients were divided in three groups of: arterial injury only, venous injury only, mixed arterial and venous injuries.ResultsA total of 2949 patients were included. All types of vessel injuries were more prevalent in patients with abdominal trauma followed by thoracic trauma. Rate of patients with shock upon admission were the same in patients with arterial injury alone (n= 606, 33%) and venous injury alone (n=95, 32%). Venous trauma showed higher odds ratio for in-hospital mortality (OR: 1.48; 95% CI 1.10-1.98, p=0.010).ConclusionAbdominal arterial injury and venous injury were equally responsible for the rate of hemodynamic instability at the time of admission. However, the proportion of adverse outcome during hospital stay was significantly higher in patients with venous injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible retroperitoneal hematoma caused by subtle venous injury.

scholarly journals Prevalence and Outcome of Abdominal Vascular Injury in Severe Trauma Patients – An International Registry Analysis

2021 ◽  
Author(s):  
Mohammad Esmaeil Barbati ◽  
Frank Hildebrand ◽  
Hagen Andruszkow ◽  
Rolf Lefering ◽  
Michael Jacobs ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Hemodynamic Instability ◽  
Arterial Injury ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Venous Injury ◽  
Major Vessel ◽  
Time Of Admission ◽  
Abdominal Vascular Injuries

Abstract BackgroundAbdominal vascular injuries and the resulting hemorrhagic shock are still one of the main causes of death in trauma patients. This study details the etiology, frequency and effect of major vessel lesions of the abdomen in patients after polytrauma.Patients and methodsAll patients of TraumaRegister DGU® who met the following criteria were included: online documentation of European trauma centers, age 16-85 years, presence of abdominal vascular injury, and AIS ≥ 3. Patients were divided in three groups based on the type of vessel injuries: arterial injury only, venous injury only, mixed arterial and venous injuries.ResultsA total of 2949 patients met the inclusion criteria. A blunt mechanism of abdominal vascular injuries was more frequent in all three groups. All types of vessel injuries were more prevalent in patients with relevant abdominal trauma followed by relevant thoracic trauma. On admission to hospital the rate of patients with shock were the same in patients with arterial injury alone (n= 606, 33%) and venous injury alone (n=95, 32%). Patients with venous injury alone or together with arterial injuries had higher early (within first 24h) mortality rates (isolated arterial injury OR: 1.31; 95%, CI 1.14-1.50, p<0.001; isolated venous injury OR: 1.48; 95%, CI 1.10-1.98, p=0.010) and also in-hospital mortality.ConclusionAbdominal arterial injury and venous injury were equally responsible for the rate of hemodynamic instability at the time of admission. However, the proportion of adverse outcome during hospital stay was significantly higher in patients with venous injury. Stable patients suspected of abdominal vascular injuries should be further investigated to exclude or localize the possible retroperitoneal hematoma caused by subtle venous injury.

scholarly journals Association between vascular injury identified via echo-Doppler examination and talus fracture-dislocation

2018 ◽  
Vol 12 (2) ◽  
pp. 84-89
Author(s):  
Andresa Ramires Hoshino Ferreira ◽  
Rui Dos Santos Barroco ◽  
Álvaro Diego Pupa De Freitas ◽  
Bruno Rodrigues De Miranda ◽  
Letícia Zaccaria Prates de Oliveira ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Arterial Injury ◽  
Lower Limbs ◽  
Fracture Dislocation ◽  
Vascular Injuries ◽  
Colour Doppler ◽  
Talus Fracture ◽  
Level Of Evidence ◽  
Doppler Examination ◽  
Venous Injury

Objective: To investigate the association between talus fracture-dislocation and the occurrence of pre-operative vascular injuries identified via echo-colour Doppler examination of the lower limbs and to assess whether these injuries directly affect talar necrosis. Methods: Retrospective study with data collection on 26 patients with a diagnosis of talus fracture-dislocation who were evaluated by pre-operative arterial and venous echo-colour Doppler from 2004 to 2015. Results: The sample included 26 patients (26 feet), ranging in age from 16 to 62 years, with a mean follow-up time of 2 years and 9 months. A total of six (23.07%) changes were diagnosed via echo-colour Doppler, of which five (83.33%) were due to arterial injury of the ‘segmental occlusion of the posterior tibial artery’ type and one (16.67%) was due to venous injury of the ‘recent deep venous thrombosis of the popliteal-distal segment’ type, with no arterial injury. No significant association was found between the vascular injuries diagnosed by Doppler and progression to necrosis. Conclusion: A significant portion of the patients with talus fracture-dislocation presented with vascular injury diagnosed by echo-colour Doppler, although no association was found between vascular injury and outcomes of osteonecrosis. Level of Evidence IV; Diagnostic studies.

Factors Contributing to Morbidity after Combined Arterial and Venous Lower Extremity Trauma

2018 ◽  
Vol 84 (7) ◽  
pp. 1217-1222 ◽  
Author(s):  
Nathan R. Manley ◽  
Louis J. Magnotti ◽  
Timothy C. Fabian ◽  
Michael B. Cutshall ◽  
Martin A. Croce ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Arterial Injury ◽  
Vascular Trauma ◽  
Trauma Patients ◽  
Secondary Intervention ◽  
Ischemic Time ◽  
Packed Red Blood Cells ◽  
Venous Injury ◽  
Arterial And Venous Injuries ◽  
The Impact

The purpose of this study was to evaluate the impact of management of venous injury on clinical outcomes in patients with combined lower extremity arterial and venous trauma. Patients with common and external iliac, common and superficial femoral, and popliteal artery injuries were identified. Patients who underwent vein repair and those who received vein ligation were compared. The analysis was repeated for those patients who required secondary intervention for their arterial injury and those who did not require secondary intervention. Seventy patients were identified with both arterial and venous injuries: 40 underwent vein ligation and 30 received vein repair. There was no difference in ischemic time between patients undergoing vein repair compared with ligation. Vein ligation did not produce a higher incidence of muscle debridement (10% vs 15%, P = 0.72), necessity for secondary intervention (10% vs 7.5%, P = 0.99), or amputation (3.3% vs 7.5%, P = 0.63). Patients who required secondary intervention had a greater degree of shock on presentation (packed red blood cells (PRBC), 13 units vs 6 units, P = 0.02) and were more likely to require muscle debridement (50% vs 9%, P = 0.02) and amputation (33% vs 3%, P = 0.03). Vein ligation did not impact muscle ischemia or success of arterial repair in patients with combined venous and arterial trauma in the lower extremities. Patient morbidity after extremity vascular trauma is most related to degree of shock.

scholarly journals The impact of infection complications after trauma differs according to trauma severity

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Akira Komori ◽  
Hiroki Iriyama ◽  
Takako Kainoh ◽  
Makoto Aoki ◽  
Toshio Naito ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Severe Trauma ◽  
Multivariable Logistic Regression Analysis ◽  
Trauma Patients ◽  
Trauma Severity ◽  
Baseline Characteristics ◽  
General Wards ◽  
The Impact

AbstractThe impact of infection on the prognosis of trauma patients according to severity remains unclear. We assessed the impact of infection complications on in-hospital mortality among patients with trauma according to severity. This retrospective cohort study used a nationwide registry of trauma patients. Patients aged ≥ 18 years with blunt or penetrating trauma who were admitted to intensive care units or general wards between 2004 and 2017 were included. We compared the baseline characteristics and outcomes between patients with and without infection and conducted a multivariable logistic regression analysis to investigate the impact of infection on in-hospital mortality according to trauma severity, which was classified as mild [Injury Severity Score (ISS) < 15], moderate (ISS 15–29), or severe (ISS ≥ 30). Among the 150,948 patients in this study, 10,338 (6.8%) developed infections. Patients with infection had greater in-hospital mortality than patients without infection [1085 (10.5%) vs. 2898 (2.1%), p < 0.01]. After adjusting for clinical characteristics, in-hospital mortality differed between trauma patients with and without infection according to trauma severity [17.1% (95% CI 15.2–18.9%) vs. 2.9% (95% CI 2.7–3.1%), p < 0.01, in patients with mild trauma; 14.8% (95% CI 13.3–16.3%) vs. 8.4% (95% CI 7.9–8.8%), p < 0.01, in patients with moderate trauma; and 13.5% (95% CI 11.2–15.7%) vs. 13.7% (95% CI 12.4–14.9%), p = 0.86, in patients with severe trauma]. In conclusion, the effect of infection complications in patients with trauma on in-hospital mortality differs by trauma severity.

scholarly journals The Impact of Accidental Hypothermia on Mortality in Trauma Patients Overall and Patients with Traumatic Brain Injury Specifically: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 44 (12) ◽  
pp. 4106-4117
Author(s):  
David Rösli ◽  
Beat Schnüriger ◽  
Daniel Candinas ◽  
Tobias Haltmeier
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Accidental Hypothermia ◽  
Trauma Patients ◽  
Qualitative Synthesis ◽  
Pubmed Database ◽  
The Impact

Abstract Background Accidental hypothermia is a known predictor for worse outcomes in trauma patients, but has not been comprehensively assessed in a meta-analysis so far. The aim of this systematic review and meta-analysis was to investigate the impact of accidental hypothermia on mortality in trauma patients overall and patients with traumatic brain injury (TBI) specifically. Methods This is a systematic review and meta-analysis using the Ovid Medline/PubMed database. Scientific articles reporting accidental hypothermia and its impact on outcomes in trauma patients were included in qualitative synthesis. Studies that compared the effect of hypothermia vs. normothermia at hospital admission on in-hospital mortality were included in two meta-analyses on (1) trauma patients overall and (2) patients with TBI specifically. Meta-analysis was performed using a Mantel–Haenszel random-effects model. Results Literature search revealed 264 articles. Of these, 14 studies published 1987–2018 were included in the qualitative synthesis. Seven studies qualified for meta-analysis on trauma patients overall and three studies for meta-analysis on patients with TBI specifically. Accidental hypothermia at admission was associated with significantly higher mortality both in trauma patients overall (OR 5.18 [95% CI 2.61–10.28]) and patients with TBI specifically (OR 2.38 [95% CI 1.53–3.69]). Conclusions In the current meta-analysis, accidental hypothermia was strongly associated with higher in-hospital mortality both in trauma patients overall and patients with TBI specifically. These findings underscore the importance of measures to avoid accidental hypothermia in the prehospital care of trauma patients.

A critical appraisal of impact of compounding factors in limb salvage decision making in combat extremity vascular trauma

2020 ◽  
pp. bmjmilitary-2020-001508 ◽  
Author(s):  
Amila S Ratnayake ◽  
M Bala ◽  
C J Fox ◽  
A U Jayatilleke ◽  
S P B Thalgaspitiya ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Vascular Reconstruction ◽  
Arterial Injury ◽  
Vascular Trauma ◽  
Large Animal ◽  
Vascular Injuries ◽  
Skeletal Trauma ◽  
Anatomy And Physiology ◽  
Arterial Injuries ◽  
The Impact

ObjectiveFor more than half a century, surgeons who managed vascular injuries were guided by a 6-hour maximum ischaemic time dogma in their decision to proceed with vascular reconstruction or not. Contemporary large animal survival model experiments aimed at redefining the critical ischaemic time threshold concluded this to be less than 5 hours. Our clinical experience from recent combat vascular trauma contradicts this dogma with limb salvage following vascular reconstruction with an average ischaemic time of 6 hours.MethodsDuring an 8-month period of the Sri Lankan Civil War, all patients with penetrating extremity vascular injuries were prospectively recorded by a single surgeon and retrospectively analysed. A total of 76 arterial injuries was analysed for demography, injury anatomy and physiology, treatment and outcomes. Subsequent statistical analysis was performed to evaluate the impact of independent variables to include; injury anatomy, concomitant venous, skeletal trauma, shock at presentation and time delay from injury to reconstruction.ResultsIn this study, the 76 extremity arterial injuries had a median ischaemic time of 290 (IQR 225–375) min. Segmental arterial injury (p=0.02), skeletal trauma (p=0.05) and fasciotomy (p=0.03) were found to have a stronger correlation to subsequent amputation than ischaemic time.ConclusionsMultiple factors affect limb viability following compromised distal circulation and our data show a trend towards various subsets of limbs that are more vulnerable due to inherent or acquired paucity of collateral circulation. Early identification and prioritisation of these limbs could achieve functional limb salvage if recognised. Further prospective research should look into the clinical, biochemical and morphological markers to facilitate selection and prioritisation of limb revascularisation.

scholarly journals The impact of shorter prehospital transport times on outcomes in patients with abdominal vascular injuries

2013 ◽  
Vol 7 (1) ◽  
Author(s):  
Chad G Ball ◽  
Brian H Williams ◽  
Clarisse Tallah ◽  
Jeffrey P Salomone ◽  
David V Feliciano
Keyword(s):  
Vascular Injuries ◽  
The Impact ◽  
Abdominal Vascular Injuries

scholarly journals Incidence and prognosis of myocardial injury in patients with severe trauma

2021 ◽  
Author(s):  
Alexandra Stroda ◽  
Simon Thelen ◽  
René M’Pembele ◽  
Antony Adelowo ◽  
Carina Jaekel ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Hospital Mortality ◽  
Myocardial Injury ◽  
Injury Severity ◽  
Troponin T ◽  
Characteristic Curve ◽  
Severe Trauma ◽  
University Hospital ◽  
Resuscitation Room ◽  
The Impact

Abstract Purpose Severe trauma can lead to end organ damages of varying severity, including myocardial injury. In the non-cardiac surgery setting, there is extensive evidence that perioperative myocardial injury is associated with increased morbidity and mortality. The impact of myocardial injury on outcome after severe trauma has not been investigated adequately yet. We hypothesized that myocardial injury is associated with increased in-hospital mortality in patients with severe trauma. Materials/methods This retrospective cohort study included patients ≥ 18 years with severe trauma [defined as injury severity score (ISS) ≥ 16] that were admitted to the resuscitation room of the Emergency Department of the University Hospital Duesseldorf, Germany, between 2016 and 2019. The main endpoint was in-hospital mortality. Main exposure was myocardial injury at arrival [defined as high-sensitive troponin T (hsTnT) > 14 ng/l]. For statistical analysis, receiver operating characteristic curve (ROC) and multivariate binary logistic regression were performed. Results Out of 368 patients, 353 were included into statistical analysis (72.5% male, age: 55 ± 21, ISS: 28 ± 12). Overall in-hospital mortality was 26.1%. Myocardial injury at presentation was detected in 149 (42.2%) patients. In-hospital mortality of patients with and without myocardial injury at presentation was 45% versus 12.3%, respectively. The area under the curve (AUC) for hsTnT and mortality was 0.76 [95% confidence interval (CI) 0.71–0.82]. The adjusted odds ratio of myocardial injury for in-hospital mortality was 2.27 ([95%CI 1.16–4.45]; p = 0.017). Conclusion Myocardial injury after severe trauma is common and independently associated with in-hospital mortality. Thus, hsTnT might serve as a new prognostic marker in this cohort.

scholarly journals Computed Tomography Angiography is the Definitive Vascular Imaging Modality for Penetrating Neck Injury: A South African Experience

2017 ◽  
Vol 107 (1) ◽  
pp. 23-30 ◽  
Author(s):  
A. S. Madsen ◽  
V. Y. Kong ◽  
G. V. Oosthuizen ◽  
J. L. Bruce ◽  
G. L. Laing ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Vascular Injury ◽  
Computed Tomography Angiography ◽  
Imaging Modality ◽  
Arterial Injury ◽  
Vascular Trauma ◽  
Neck Injury ◽  
Predictive Values ◽  
Venous Injury ◽  
Penetrating Neck Injury

Background and Aims: Computed tomography angiography has become central to the diagnostic algorithm for penetrating neck injury, but despite its widespread use the literature to support this adoption is limited. We reviewed our experience with computed tomography angiography for the identification of vascular trauma in hemodynamically stable patients with penetrating neck injury at a major trauma center in South Africa. Materials and Methods: A prospectively kept trauma registry capturing data in real time was retrospectively reviewed. All patients with penetrating neck injury investigated with computed tomography angiography as the initial vascular investigation during a 47-month period were included. Results: A total of 380 patients were included. Indications for computed tomography angiography were as follows: hard signs (13), soft signs (201), no signs but proximity/zone I or III wounds (141), and undefined signs of vascular injury (25). Of the 380 scans, 7 (1.8%) were indeterminate, 299 (78.7%) negative, and 74 (19.5%) positive for a vascular injury (54 arterial and 20 isolated venous injury). Eight were false positive and 4 false negative. The sensitivity, specificity, positive, and negative predictive values for detecting arterial injury were 93.9%, 97.5%, 85.2%, and 99.1%, respectively. Overall, the yield for demonstrating “true arterial injury” was 12.1% (46/380); hard signs: 76.9% (10/13), soft signs: 16.4% (33/201), and no signs: 2.1% (3/141) which all were secondary to gunshot wounds). Only 8.4% (32/380) required intervention for arterial injury and none for isolated venous injury (hard signs: 62.0%, soft signs: 11.4%, and no signs: 0.7%). No serious complications resulted from computed tomography angiography. Conclusion: Computed tomography angiography is a safe and effective imaging modality for the investigation of vascular trauma post penetrating neck injury. Asymptomatic patients with stab wounds do not need to be imaged regardless of proximity concerns. Symptomatic stable patients including a subgroup with hard signs should be imaged rather than explored. Computed tomography angiography provides an interventional road map and can identify injuries amenable to endovascular or conservative management.

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