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Management of vascular trauma across Canada: A cohort study with implications for practice
Shane Smith1, Laura Allen1, Kosar Khwaja2
1London Health Sciences Centre, London, Ontario, Canada.
Insights
This study analyzed 1330 Canadian vascular trauma patients, finding varied injury types and management strategies. Outcomes highlight the need for improved practice and knowledge translation in vascular injury care.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Emergency Medicine
Background:
- Vascular trauma presents a significant challenge in trauma care.
- Understanding injury patterns and management is crucial for improving patient outcomes.
Purpose of the Study:
- To describe the characteristics and management of major vascular injuries in Canadian trauma centers.
- To identify trends in injury mechanisms, treatment strategies, and clinical outcomes.
Main Methods:
- Retrospective cohort study of 1330 adult patients with major vascular injuries from 8 Canadian Level 1 trauma centers (2011-2015).
- Data included demographics, injury mechanism, vessel injured, management approach, and outcomes.
- Major vascular injury defined as damage to named arteries or veins in limbs, torso, or neck.
Main Results:
- Most injuries (63%) were blunt, commonly from motor vehicle collisions (36%).
- Neck (32%) and abdomen/pelvis (27%) were frequent injury sites; transection was the most common injury type (50%).
- Management varied, including non-operative (32%), open surgery (24%), and endovascular (9%); 13% in-hospital mortality and 2% amputation rate.
Conclusions:
- Significant variability exists in vascular injury mechanisms, management, and responsible specialists across Canadian trauma centers.
- Findings underscore the need for practice standardization and knowledge translation to optimize vascular trauma care.
Background:
The aim of this study was to provide a description of vascular trauma and its management at trauma centers across Canada.
Methods:
This retrospective cohort study evaluated patients from 8 Canadian level 1 trauma centers (2011-2015). Medical records were queried to identify adult patients who survived to hospital with major vascular injury. Major vascular injury was defined as injury to named arterial or venous vessels in the legs, arms torso, and neck. Data collected included patient demographics, injury mechanism, injury details, management and clinical outcomes.
Results:
A total of 1330 patients were included. Patients were 76% male with a mean age of 43 (SD 18.8). Reported injuries were 63% blunt, 36% penetrating, and the remainder mixed. The most common specific mechanisms of injury were motor vehicle collision (36%), stabbing (26%), and falls (16%), with gunshot injuries accounting for <5%. Pre-hospital tourniquets were applied in 27 patients (2%). The mean Injury Severity Score (ISS) was 24 (SD 14.5). We identified injuries to named vessels of the neck (32%), thorax (23%), abdomen and pelvis (27%), upper extremity (14%) and lower extremity (10%). Specific vascular injuries included transection (50%), complete occlusion (11%), partial occlusion (39%), and pseudoaneurysm formation (11%). Injuries were managed non-operatively in 32%, with definitive open surgical management (24%), endovascular management (9%) and with damage control techniques in the operating room (3%). Amputation occurred in 10% of lower extremity and 5% of upper extremity injuries. Responsibility for vascular injury management was undertaken by a wide variety of specialists (n = 17). Overall, in-hospital mortality was 13%, and 2% of patients underwent amputation.
Conclusion:
This study describes the nature and management of vascular injuries across Canada. The variability in injury mechanisms, management strategies, specialty responsible for management, and outcomes have important implications for practice change and knowledge translation.
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