Selective Conservatism vs Mandatory Exploration – Lessons from Managing Traumatic Vascular Injuries

Abstract

Introduction: Vascular trauma though accounting for only 2-3% of overall injuries in a trauma patient is often the most urgent due to risk of rapid exsanguination. Incidence of penetrating injuries is increasing at a rapid rate across our cities with increasing knife crime. We present a review of all vascular injuries in trauma patients over a 5-year period. Methods: Data was collected from 2012-2017 using a prospectively maintained trauma database (Trauma and research Network-TARN) and electronic patient records. All patients admitted as a major trauma call and identified as having a vascular injury were included. Individual patient records were examined to assess injury characteristics, demographics and outcomes. Results: A total of 203 vascular injuries cases were recorded on the trauma database during the study period. The mean injury severity score was 17, with 46 (69%) patients meeting the criteria of 'major trauma' with a score greater than 15.There were 172 (85%) male patients and 31 (15%) female patients. A total of 82 cases were due to road traffic accidents (RTA) and 73 were due to stabbings. The majority (84%) of the stabbing victims were male. Median age for patients who came in with a stabbing injury was 26.2 years compared to 43 years for RTA patients. Stabbing injuries most frequently required vascular surgery with 75% of the cases (55 out of 73) requiring urgent vascular surgery compared to 46% of the RTA cases (38 out of 82). Of the stab injuries 82% were arterial with 7% patients having an additional visceral injury. The anatomical site of the injury was the thorax in 48%, abdomen and pelvic in 30%, head and neck in 11%, lower limb in 8% and upper limb in 3%. In RTA too the majority (80%) of injuries were arterial, with 14% suffering associated visceral damage. The commonest anatomic location of injury was abdominal and pelvic injuries (41%), lower limbs (30%) and thorax (14%). Median time from admission to theatre was 1.6 hours. Interventional radiology was needed in 11%. 52% patients required more than one operation. Mortality from stab injuries was 3%, compared to 13% in the RTA group. Conclusion: The majority of traumatic vascular injuries from stabbings need immediate surgery and inspite of major vessels being involved the outcomes are good and mortality is low in this cohort of young patients. On the other hand vascular injuries associated with RTA are associated with poorer outcomes due to other associated injuries. Disclosure: Nothing to disclose