PC212. Management of Vascular Injuries From Stabbings

Abstract

The total number of knife offenses in Britain is at the highest level in 6 years. In 2017, hospital admissions for knife assault wounds increased by 21%. At a single major trauma center, we reviewed all stabbings resulting in vascular injury during a 5-year period and evaluated patients’ demographics, anatomy of injury, management, and outcomes. Data were collected from 2012 to 2017 using a prospectively maintained trauma database and electronic patient records. All patients admitted as a major trauma call and identified as having a vascular injury from a stabbing were included. Individual patient records were examined to assess injury characteristics, operations, demographics, and outcomes. In total, 186 trauma patients were identified as having major vascular trauma. Of these, 66 (35%) patients were injured by stabbing. The median age was 27 (range, 15-58) years, with the majority (92%) being male. The mean Injury Severity Score was 17, with 46 (69%) patients meeting the criteria of major trauma with a score >15. Of the injuries, 55 (82%) were arterial and 18 (26%) venous; 10 involved both (15%). In five (7%) patients, there was also visceral involvement. The anatomic site of the injury was the thorax in 32 cases (48%), abdomen and pelvis in 20 patients (30%), head and neck in 7 (11%), lower limb in 5 (8%), and upper limb in 4 (3%). A vascular operation, deemed to be a direct surgical repair to a vessel, was required in 50 (76%) patients, other operation in 5 patients (8%), interventional radiology in 7 patients (11%), and conservative management only in 4 patients (6%). In the operatively managed cohort, median time from admission to theater was 1.6 hours. Median length of hospital stay was 7 days (range, 1-365 days). Despite injuries involving major vessels, there were only two deaths (3%), one from injury to the pulmonary artery and one to the inferior vena cava. In a major trauma center with onsite vascular services, the majority of traumatic vascular injuries from stabbings can be treated without prolonged hospital stay and low mortality.