Joseph J DuBose1, Stephanie A Savage, Timothy C Fabian, Jay Menaker, Thomas Scalea, John B Holcomb, David Skarupa, Nathaniael Poulin, Konstantinos Chourliaras, Kenji Inaba, Todd E Rasmussen. 1. From the University of Texas Health Sciences Center-Houston (J.J.D., J.B.H.), Houston, Texas; University of Tennessee Health Sciences Center-Memphis (S.A.S., T.C.F.), Memphis, Tennessee; R Adams Cowley Shock Trauma Center (J.M., T.S., T.E.R.), University of Maryland, Baltimore, Maryland; University of Florida-Jacksonville (D.S.), Jacksonville, Florida; East Carolina Medical Center (N.P.), Benson, North Carolina; and Los Angeles County + University of Southern California Hospital (K.C., K.I.), Los Angeles, California.
Abstract
BACKGROUND: There is a need for a prospective registry designed to capture trauma-specific, in-hospital, and long-term outcomes related to vascular injury. METHODS: The American Association for the Surgery of Trauma PROspective Vascular Injury Treatment (PROOVIT) registry was used to collect demographic, diagnostic, treatment, and outcome data on vascular injuries. RESULTS: A total of 542 injuries from 14 centers (13 American College of Surgeons-verified Level I and 1 American College of Surgeons-verified Level II) have been captured since February 2013. The majority of patients are male (70.5%), with an Injury Severity Score (ISS) of 15 or greater among 32.1%. Penetrating mechanisms account for 36.5%. Arterial injuries to the head/neck (26.7%), thorax (10.4%), abdomen/pelvis (7.8%), upper extremity (18.4%), and lower extremity (26.0%) were identified, along with 98 major venous injuries. Hard signs of vascular injury, including hypotension (systolic blood pressure < 90 mm Hg, 11.8%), were noted in 28.6%. Prehospital tourniquet use for extremity injuries occurred in 20.2% (47 of 233). Diagnostic modalities included exploration (28.8%), computed tomographic angiography (38.9%), duplex ultrasound (3.1%), and angiography (10.7%). Arterial injuries included transection (24.3%), occlusion (17.3%), partial transection/flow limiting defect (24.5%), pseudoaneurysm (9.0%), and other injuries including intimal defects (22.7%). Nonoperative management was undertaken in 276 (50.9%), with failure in 4.0%. Definitive endovascular and open repair were used in 40 (7.4%) and 126 (23.2%) patients, respectively. Damage-control maneuvers were used in 57 (10.5%), including ligation (31, 5.7%) and shunting (14, 2.6%). Reintervention of initial repair was required in 42 (7.7%). Amputation was performed in 7.7% of extremity vascular injuries, and overall hospital mortality was 12.7%. Follow-up ranging from 1 month to 7 months is available for 48 patients via a variety of modalities, with reintervention required in 1 patient. CONCLUSION: The PROOVIT registry provides a contemporary picture of the management of vascular injury. This resource promises to provide needed information required to answer questions about optimal diagnosis and management of these patients-including much needed long-term outcome data. LEVEL OF EVIDENCE: Epidemiologic study, level V.
BACKGROUND: There is a need for a prospective registry designed to capture trauma-specific, in-hospital, and long-term outcomes related to vascular injury. METHODS: The American Association for the Surgery of Trauma PROspective Vascular Injury Treatment (PROOVIT) registry was used to collect demographic, diagnostic, treatment, and outcome data on vascular injuries. RESULTS: A total of 542 injuries from 14 centers (13 American College of Surgeons-verified Level I and 1 American College of Surgeons-verified Level II) have been captured since February 2013. The majority of patients are male (70.5%), with an Injury Severity Score (ISS) of 15 or greater among 32.1%. Penetrating mechanisms account for 36.5%. Arterial injuries to the head/neck (26.7%), thorax (10.4%), abdomen/pelvis (7.8%), upper extremity (18.4%), and lower extremity (26.0%) were identified, along with 98 major venous injuries. Hard signs of vascular injury, including hypotension (systolic blood pressure < 90 mm Hg, 11.8%), were noted in 28.6%. Prehospital tourniquet use for extremity injuries occurred in 20.2% (47 of 233). Diagnostic modalities included exploration (28.8%), computed tomographic angiography (38.9%), duplex ultrasound (3.1%), and angiography (10.7%). Arterial injuries included transection (24.3%), occlusion (17.3%), partial transection/flow limiting defect (24.5%), pseudoaneurysm (9.0%), and other injuries including intimal defects (22.7%). Nonoperative management was undertaken in 276 (50.9%), with failure in 4.0%. Definitive endovascular and open repair were used in 40 (7.4%) and 126 (23.2%) patients, respectively. Damage-control maneuvers were used in 57 (10.5%), including ligation (31, 5.7%) and shunting (14, 2.6%). Reintervention of initial repair was required in 42 (7.7%). Amputation was performed in 7.7% of extremity vascular injuries, and overall hospital mortality was 12.7%. Follow-up ranging from 1 month to 7 months is available for 48 patients via a variety of modalities, with reintervention required in 1 patient. CONCLUSION: The PROOVIT registry provides a contemporary picture of the management of vascular injury. This resource promises to provide needed information required to answer questions about optimal diagnosis and management of these patients-including much needed long-term outcome data. LEVEL OF EVIDENCE: Epidemiologic study, level V.
Authors: Melissa N Loja; Amanda Sammann; Joseph DuBose; Chin-Shang Li; Yu Liu; Stephanie Savage; Thomas Scalea; John B Holcomb; Todd E Rasmussen; M Margaret Knudson Journal: J Trauma Acute Care Surg Date: 2017-03 Impact factor: 3.313
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