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Using Arterial Pressure Index to Predict Arterial Injuries in Penetrating Trauma to the Upper Extremities
Lily Tung1, Mark J Seamon1, Elizabeth Dauer2
1Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.
The American Surgeon
|April 20, 2021
Summary
Arterial pressure index (API) is not a reliable tool for diagnosing penetrating upper extremity (UE) vascular injuries. Further investigation is needed to determine the best diagnostic algorithm for these specific injuries.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Diagnostic Imaging
Background:
- Upper extremity (UE) vascular injuries constitute 18.4% of all traumatic vascular injuries.
- Arterial pressure index (API) is established for lower extremity injuries but its utility in UE trauma is uncertain due to collateral circulation.
Purpose of the Study:
- To evaluate the effectiveness of Arterial Pressure Index (API) in identifying the need for computed tomography angiography (CTA) in patients with penetrating upper extremity trauma.
Main Methods:
- Retrospective analysis of adult trauma patients with penetrating UE trauma and API measurements from 2006-2016 across three Level 1 trauma centers.
- Calculated sensitivity, specificity, and predictive values of API < 0.9 for detecting UE arterial injuries.
Main Results:
- 218 patients met inclusion criteria; 76.6% sustained gunshot wounds.
- Median Injury Severity Score was 9; median API was 1.
- 72 patients underwent CTA, revealing thrombus/occlusion (46.7%), transection (23.1%), and dissection (15.4%) as common injuries. 32 patients required surgery.
Conclusions:
- The study suggests that API < 0.9 has limited utility in ruling out arterial injury in penetrating UE trauma.
- Further research is needed to establish optimal diagnostic strategies for UE vascular injuries.
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