Trauma Data Bank Info May Help Predict Vascular Trauma Outcomes

LAKE BUENA VISTA, FLA. – Vascular trauma accounts for less than 2% of all traumatic injuries, and aggressive management achieves improved survival in most cases that involve critical vascular injury – particularly those resulting from blunt trauma – according to an analysis of data from the 2008 National Trauma Data Bank.

Of 113,218 trauma cases in the data bank, 2,089 (1.8%) were in patients who experienced a total of 2,102 vascular injuries. The most common causes of vascular trauma were motor vehicle accidents, gunshot wounds, and stabbings, which accounted for 44%, 22.8% and 15.9% of the injuries, respectively, Dr. Sapan S. Desai reported at the annual meeting of the Society for Clinical Vascular Surgery.

About 75% of the injuries were to a lower extremity, upper extremity, or the carotid artery; 14% were to visceral arteries; and 11% affected the thoracic or abdominal aorta. Blunt trauma accounted for the majority of most types of injury (73% of all carotid artery injuries and 81% of all thoracic injuries, for example), with the exception of upper extremity injuries, which were caused by penetrating trauma in about 60% of cases.

Subgroup analyses identified several complications that contributed significantly to overall mortality: Death occurred in 16% of those who developed a coagulopathy, 15% of those with cardiac arrest, 9% of those with acute respiratory distress syndrome, 7% of those with sepsis, 5% of those with acute renal failure, and 3% of those with bleeding, said Dr. Desai of Duke University, Durham, N.C.

When injuries were grouped by severity score, and survival was evaluated as a function of conservative vs. aggressive management, blunt trauma patients were shown to have better survival following an open procedure than following an imaging study or endovascular management – there was nearly a 20% difference in survival, which was statistically significant. However, patients with blunt thoracic aortic trauma fared better after endovascular intervention, also with a 20% improvement in survival, Dr. Desai said. Thus, endovascular intervention for the sickest patients had the best outcome and significantly greater survival compared with open intervention and imaging studies alone, he added.

Aggressive monitoring for – and treatment of – the complications found to commonly occur in vascular trauma patients could improve survival, he concluded, noting that the identification of comorbidities such as diabetes, prior stroke, and prior MI, which are associated with vascular injury patterns, should raise the index of suspicion for certain vascular injuries.

During a discussion period, concerns were raised about the inherent limitations of using a database such as the National Trauma Data Bank to draw conclusions such as these.

In response, Dr. Desai agreed that the ability to confirm accuracy and completeness of the data is problematic, but the findings are strengthened by the fact that the study only included patients with coding indicating they were operative candidates.

Dr. Desai had no relevant disclosures.

LAKE BUENA VISTA, FLA. – Vascular trauma accounts for less than 2% of all traumatic injuries, and aggressive management achieves improved survival in most cases that involve critical vascular injury – particularly those resulting from blunt trauma – according to an analysis of data from the 2008 National Trauma Data Bank.

Of 113,218 trauma cases in the data bank, 2,089 (1.8%) were in patients who experienced a total of 2,102 vascular injuries. The most common causes of vascular trauma were motor vehicle accidents, gunshot wounds, and stabbings, which accounted for 44%, 22.8% and 15.9% of the injuries, respectively, Dr. Sapan S. Desai reported at the annual meeting of the Society for Clinical Vascular Surgery.

About 75% of the injuries were to a lower extremity, upper extremity, or the carotid artery; 14% were to visceral arteries; and 11% affected the thoracic or abdominal aorta. Blunt trauma accounted for the majority of most types of injury (73% of all carotid artery injuries and 81% of all thoracic injuries, for example), with the exception of upper extremity injuries, which were caused by penetrating trauma in about 60% of cases.

Subgroup analyses identified several complications that contributed significantly to overall mortality: Death occurred in 16% of those who developed a coagulopathy, 15% of those with cardiac arrest, 9% of those with acute respiratory distress syndrome, 7% of those with sepsis, 5% of those with acute renal failure, and 3% of those with bleeding, said Dr. Desai of Duke University, Durham, N.C.

When injuries were grouped by severity score, and survival was evaluated as a function of conservative vs. aggressive management, blunt trauma patients were shown to have better survival following an open procedure than following an imaging study or endovascular management – there was nearly a 20% difference in survival, which was statistically significant. However, patients with blunt thoracic aortic trauma fared better after endovascular intervention, also with a 20% improvement in survival, Dr. Desai said. Thus, endovascular intervention for the sickest patients had the best outcome and significantly greater survival compared with open intervention and imaging studies alone, he added.

Aggressive monitoring for – and treatment of – the complications found to commonly occur in vascular trauma patients could improve survival, he concluded, noting that the identification of comorbidities such as diabetes, prior stroke, and prior MI, which are associated with vascular injury patterns, should raise the index of suspicion for certain vascular injuries.

During a discussion period, concerns were raised about the inherent limitations of using a database such as the National Trauma Data Bank to draw conclusions such as these.

In response, Dr. Desai agreed that the ability to confirm accuracy and completeness of the data is problematic, but the findings are strengthened by the fact that the study only included patients with coding indicating they were operative candidates.

Dr. Desai had no relevant disclosures.

LAKE BUENA VISTA, FLA. – Vascular trauma accounts for less than 2% of all traumatic injuries, and aggressive management achieves improved survival in most cases that involve critical vascular injury – particularly those resulting from blunt trauma – according to an analysis of data from the 2008 National Trauma Data Bank.

Of 113,218 trauma cases in the data bank, 2,089 (1.8%) were in patients who experienced a total of 2,102 vascular injuries. The most common causes of vascular trauma were motor vehicle accidents, gunshot wounds, and stabbings, which accounted for 44%, 22.8% and 15.9% of the injuries, respectively, Dr. Sapan S. Desai reported at the annual meeting of the Society for Clinical Vascular Surgery.

About 75% of the injuries were to a lower extremity, upper extremity, or the carotid artery; 14% were to visceral arteries; and 11% affected the thoracic or abdominal aorta. Blunt trauma accounted for the majority of most types of injury (73% of all carotid artery injuries and 81% of all thoracic injuries, for example), with the exception of upper extremity injuries, which were caused by penetrating trauma in about 60% of cases.

Subgroup analyses identified several complications that contributed significantly to overall mortality: Death occurred in 16% of those who developed a coagulopathy, 15% of those with cardiac arrest, 9% of those with acute respiratory distress syndrome, 7% of those with sepsis, 5% of those with acute renal failure, and 3% of those with bleeding, said Dr. Desai of Duke University, Durham, N.C.

When injuries were grouped by severity score, and survival was evaluated as a function of conservative vs. aggressive management, blunt trauma patients were shown to have better survival following an open procedure than following an imaging study or endovascular management – there was nearly a 20% difference in survival, which was statistically significant. However, patients with blunt thoracic aortic trauma fared better after endovascular intervention, also with a 20% improvement in survival, Dr. Desai said. Thus, endovascular intervention for the sickest patients had the best outcome and significantly greater survival compared with open intervention and imaging studies alone, he added.

Aggressive monitoring for – and treatment of – the complications found to commonly occur in vascular trauma patients could improve survival, he concluded, noting that the identification of comorbidities such as diabetes, prior stroke, and prior MI, which are associated with vascular injury patterns, should raise the index of suspicion for certain vascular injuries.

During a discussion period, concerns were raised about the inherent limitations of using a database such as the National Trauma Data Bank to draw conclusions such as these.

In response, Dr. Desai agreed that the ability to confirm accuracy and completeness of the data is problematic, but the findings are strengthened by the fact that the study only included patients with coding indicating they were operative candidates.

Dr. Desai had no relevant disclosures.