Global Disparity Within the Management of Traumatic Abdominal Vascular Injuries: Analysis of a Global Dataset

Vascular injuries are common to trauma and carry a high risk to limb and life. Integrating specialist vascular care into existing trauma systems is essential; however, global data on this topic remains limited. This study describes global patterns of abdominal vascular trauma, through secondary analysis of the Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) study dataset, examining system- and patient-level differences across resource settings.

Patients of any age with blunt or penetrating trauma who underwent an abdominal vascular procedure during trauma laparotomy were included. Patient characteristics, injury patterns, peri-operative factors, and outcomes were recorded. Data were summarized using descriptive statistics and differences across Human Development Index (HDI) tertiles were analyzed with the Kruskal-Wallis or χ² tests, where appropriate.

A total of 178 patients from 82 hospitals across 33 countries were included, representing one in 10 patients (178 of 1769) of the original dataset. A higher proportion of patients had vascular procedures in the upper HDI tertile (64 of 492, 13.0%), compared to middle (82 of 714, 11.5%) and lower (32 of 563, 5.7%) HDI tertiles. The median time from injury to operation was 5.0 hours (IQR 2.0-9.0). Among patients who were hypotensive on presentation, time from arrival to operation was significantly longer in the lower HDI tertile (p = 0.033). The most common regions of vascular injury were the inferior vena cava (37 patients, 20.8%) and iliac vein (30 patients, 16.9%). Thirty day post-operative mortality was 17.4% (31 of 178 patients), with only around half of the patients (94 of 178, 52.8%) discharged to their usual place of residence.

As trauma systems become integrated into national healthcare services, prioritizing vascular care is crucial. There remains considerable variation in the provision of vascular services in trauma globally, yet given the time-critical nature of vascular injuries, it is essential to ensure effective, integrated care pathways.