Vascular trauma at a military level II trauma center

Abstract

Purpose As members of an American College of Surgeons Committee on Trauma–designated level II trauma center, we decided to review our experience with vascular trauma. In addition, we sought to characterize the vascular injuries presented and to compare our outcomes to the general trauma population. Methods A review of all vascular trauma admissions from January 1997 through January 2000 was performed. The William Beaumont Army Medical Center (WBAMC) trauma registry data base was searched for vascular injuries utilizing 3 different search criteria: organ system, operation/procedure, and ICD-9 codes. Injuries were then characterized by age, gender, site of injury, injury severity score (ISS), mechanism, and need for surgery. Mortality rates were computed for both vascular and nonvascular trauma populations. Statistical analysis of the data was determined by Student t test and z score. Results Between January 1997 and January 2000, there were 1398 patients admitted to the trauma service at WBAMC. Of these, 48 patients (3.4%) had vascular injuries. The mean ISS for all nonvascular traumas was 8.4 ± 8.9. The mean ISS for those with vascular injuries was 17.9 ± 12.6 (p < 0.001). Blunt trauma accounted for 90% of all nonvascular admissions. Penetrating trauma accounted for 10% of all nonvascular admissions. In the vascular trauma population, blunt trauma accounted for 56% and penetrating trauma accounted for 39%. Five percent of the vascular injuries identified were iatrogenic. Surgical intervention was required in 85.4% and 44.2% of the vascular and nonvascular trauma populations, respectively. The mortality rate for nonvascular admissions was 4.8% (65/1350). Those with vascular injuries had a mortality rate of 20.8% (10/48). For trauma patients requiring an operation, the mortality rate was 4.5% (27/597). For patients with vascular injuries who required an operation, the mortality rate was 25.7% (9/35) (p = 0.007). Conclusions Vascular trauma represents a small percentage of all trauma admissions. These patients have a higher ISS on admission and more of them require surgical intervention. The operative and overall mortality rates are higher in patients with vascular injuries than in the general trauma population.