Predictors of Mortality for Upper Extremity Penetrating Vascular Injuries

Our objective was to determine risk factors and operative outcomes for patients with upper extremity penetrating vascular injuries (UEPVIs).

A retrospective review was performed of all adult UEPVI patients presenting to a level I trauma center between 1986 and 2019. Statistical analyses were performed to determine the independent predictors of mortality and hospital length of stay (LOS) among patients who underwent operative repair.

Among 481 UEPVI patients, the majority were male (87%), Caucasian (52%), and uninsured/underinsured (52%). Over half of injuries were caused by violent means and required surgery. Female patients had a higher injury severity score (ISS) (mean 9.55 vs 6.77, P = 0.02), were more likely to proceed urgently to the operating room (40.6% vs. 24.2%,P = 0.02),but had a lower mortality(1.6% vs. 4.8%,P = 0.009) compared to male patients. 43 (0.9%) of patients suffered amputation and 213 (44%) of patients ultimately underwent operative repair; odds ratio of mortality with an operation among all patients was 0.20 (P = 0.011, 95% confidence interval [CI]: 0.058-0.687). Among operative patients, only ISS was significant predictor of longer LOS (standardized coefficient = 0.47, 95% CI: 0.76-1.36, P < 0.001).

This retrospective analysis demonstrates that the majority of UEPVI are incurred by men and associated with violence. Operative intervention was protective with regards to mortality. Among operative patients, increased age and ISS were predictive of longer LOS.