Mesenteric Vascular Injury in Trauma: An NTDB Study
| Autor: | Suzanne Evans, Ethan Talbot, Shelby Cooper, Daphne Monie, Nicholas J. Hellenthal, Paul Campbell |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Adolescent Databases Factual Wounds Penetrating Abdominal Injuries 030204 cardiovascular system & hematology Wounds Nonpenetrating Risk Assessment 030218 nuclear medicine & medical imaging law.invention Young Adult 03 medical and health sciences Hepatic Artery Injury Severity Score 0302 clinical medicine Blunt Mesenteric Artery Superior Risk Factors law Humans Medicine Mesentery Hospital Mortality Aged Retrospective Studies business.industry Retrospective cohort study General Medicine Emergency department Middle Aged Vascular System Injuries medicine.disease Intensive care unit Early Diagnosis Treatment Outcome Abdominal trauma Blunt trauma Anesthesia Female Surgery Cardiology and Cardiovascular Medicine business Penetrating trauma |
| Zdroj: | Annals of Vascular Surgery. 70:542-548 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2020.08.101 |
| Popis: | Although abdominal trauma remains a major cause of morbidity and mortality, there has not been a large-scale multicenter study regarding outcomes in patients who incur mesenteric vascular injuries. The goal of this retrospective analysis was to investigate the factors associated with outcomes in patients with trauma diagnosed with mesenteric vascular injuries.A retrospective database analysis was performed on patients who sustained a mesenteric vascular injury (MVI, ICD-9 902.20-902.29) identified by the 2012 National Trauma Data Bank. Data were analyzed to identify differences in hospital length of stay, emergency room (ER) and final hospital disposition, and mortality based on patient age, gender, race, Injury Severity Score (ISS), and injury type (blunt or penetrating).Of the 1,133 total patients included, blunt trauma accounted for 740 (65%) of the injuries, whereas penetrating trauma accounted for 364 of the injuries (32%). Patients with penetrating injuries were 1.43 times more likely to die from their injuries than those suffering from blunt trauma (95% CI 1.04-1.98, P 0.05). Patients with a higher ISS (16) were 5.39 times more likely to die from their injuries than those with a lower ISS (95% CI 1.89-15.4, P = 0.002); if ISS was25, the patient was 15.1 times more likely to die (95% CI 5.5-41.7, P 0.001). Men were more likely to suffer from penetrating injuries than women (37% vs. 13%, P 0.001), and African Americans were nearly 4 times more likely to present with penetrating injuries (69% vs 17%, P 0.001). Age was also associated with mortality as patients65 years and between 21 and 44 years were more likely to die from their injuries than patients in other age categories. Of the 740 patients with blunt MVIs, 326 (44%) were taken directly from the ER to the operating room (OR) and 306 (41%) to the intensive care unit (ICU), whereas with penetrating MVIs, 311 (85%) were taken to the OR from the emergency department and 18 (5%) to the intensive care unit. Of the 740 blunt MVIs, 115 died (16%), compared with 76 (21%) of the penetrating MVIs (P 0.001). Injuries to the hepatic and superior mesenteric arteries were associated with higher mortality, with OR 2.03 and 3.03, respectively (P 0.001).The presence of mesenteric arterial injury warrants rapid identification and management as these injuries are associated with significant morbidity and mortality, with penetrating mechanism, injury to large mesenteric vessels, and increased ISS associated with increased mortality. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|