9 Outcomes of upper and lower extremity arterial trauma: review of over 8,000 patients from the National Trauma Data Bank.
Subject: Arterias (Investigacion cientifica)
Arterias (Analisis de casos)
Arterias (Cuidado y tratamiento)
Heridas y lesiones (Investigacion cientifica)
Heridas y lesiones (Analisis de casos)
Heridas y lesiones (Cuidado y tratamiento)
Extremidades (Anatomia) (Investigacion cientifica)
Extremidades (Anatomia) (Analisis de casos)
Extremidades (Anatomia) (Cuidado y tratamiento)
Pub Date: 06/01/2009
Publication: Name: Puerto Rico Health Sciences Journal Publisher: Universidad de Puerto Rico, Recinto de Ciencias Medicas Language: Spanish Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Universidad de Puerto Rico, Recinto de Ciencias Medicas ISSN: 0738-0658
Issue: Date: June, 2009 Source Volume: 28 Source Issue: 2
Geographic: Geographic Name: Puerto Rico
Accession Number: 201212358
Full Text: 9 Outcomes of Upper and Lower Extremity Arterial Trauma: Review of over 8,000 Patients from the National Trauma Data Bank. Fernando L Joglar *, Palma Shaw *, Robert Eberhardt *, Denis Rybin ([dagger]), Gheorghe Dorost, Alik Farber *; * Boston University Medical Center, Boston, MA, ([dagger]) Biostatistics Department, Boston University, Boston, MA

Introduction: The purpose of this study was to examine the outcome of acute arterial traumatic injuries in upper extremities (UE) compared to lower extremities (LE) and blunt compared to penetrating trauma. Method: A retrospective review of prospectively collected data from the 2008 version of the National Trauma Data Bank was performed. Using the International Classification of Diseases, Ninth Revision (ICD-9) codes, cases with a diagnosis of arterial vascular injury were identified and procedures were classified according to ICD-9 Clinical Modification codes for vascular therapy. Patients 18 years and older with traumatic blunt or penetrating arterial injury to the extremities were included in the analysis, divided into upper extremity (UE) and lower extremity (LE) injury groups and then by mechanism of injury, blunt or penetrating. A comparison of demographic information, outcomes, and major amputation rates between groups was performed using Chi-Square, T and Wilcoxon tests. Results: From 2002-2006, we identified 8,311 extremity arterial injuries among the 1,309,3 11 patients in the dataset. The patients were 82.7 male, mean age of 36.2 years, mean Glasgow Coma Scale (GCS) 13.9 [+ or -] 3.2 (14.2 [+ or -] 2.8 in UE vs. 13.5 [+ or -] 3.7 in LE, p<0.0001; 13.7 [+ or -] 3.4 in blunt vs. 14 [+ or -] 3 in penetrating, p<0.0001) and mean Injury Severity Score (ISS) 10.7 [+ or -] 9.8 (8.6 [+ or -] 8.3 in UE vs. 14.3 [+ or -] 11.1 in LE, p<0.0001; 13.0 [+ or -] 11.2 in blunt vs. 9 [+ or -] 8 in penetrating, p<0.0001). There were significantly more African Americans in LE group (p<0.0001) (Table 2). Conclusion: In the LE group there were significantly more complications, greater mean overall hospital and ICU length of stay and higher mortality. Lower extremities required more intensive intervention compared to upper extremities: there were more fasciotomies, complex soft tissue repairs and major amputations performed. Those patients with blunt mechanism of injury, regardless of the extremity, also had higher rates of these procedures as well as significantly higher complication and mortality rates compared to those with penetrating injury.
Table 2.
Variable                  Overall           Upper extremity
                          (n=8311)          (n=5260)

Blunt injury (%)          3681 (44.29)      1967 (37.4)
Penetrating injury (%)    4630 (55.71)      3293 (62.6)
Complications (%)          844 (10.16)       270 (5.13)
Mean Length                  8.06 (0-158)      5.22 (0-158)
of Stay (range)
Mean Intensive               2.6 (0-99)        1.61 (0-99)
Care Unit LOS
(range)
Mortality (%)              350 (4.21)        115 (2.19)
Fasciotomies (%)          1071 (12.89)       351 (6.67)
Complex soft
tissue repairs (%)        1035 (12.45)       541 (10.29)
Major amputations (%)      306 (3.68)         68 (1.29)

Variable                  Lower extremity   Test
                          (n=3051)          p-value

Blunt injury (%)          1714 (56.18)
Penetrating injury (%)    1337 (43.82)      <0.0001
Complications (%)          574 (18.81)      <0.0001
Mean Length                 12.97 (0-153)   <0.0001
of Stay (range)
Mean Intensive               4.1(0-99)      <0.0001
Care Unit LOS
(range)
Mortality (%)              235 (7.7)        <0.0001
Fasciotomies (%)           720 (23.6)       <0.0001
Complex soft
tissue repairs (%)         494 (16.19)      <0.0001
Major amputations (%)      238 (7.8)        <0.0001

Variable                  Blunt             Penetrating
                          injury            injury
                          (n=3681)          (n=4630)
Blunt injury (%)
Penetrating injury (%)
Complications (%)         505 (13.72)        339 (7.32)
Mean Length                 10.93 (0-134)      5.75 (0-158)
of Stay (range)
Mean Intensive               3.6 (0-90)        1.74 (0-99)
Care Unit LOS
(range)
Mortality (%)              175 (4.75)        175 (3.78)
Fasciotomies (%)           520 (14.13)       551 (11.9)
Complex soft
tissue repairs (%)         647 (17.58)       388 (8.38)
Major amputations (%)      248 (6.74)         58 (1.25)

Variable                  Test
                          p-value

Blunt injury (%)
Penetrating injury (%)
Complications (%)         <0.0001
Mean Length               <0.0001
of Stay (range)
Mean Intensive            <0.0001
Care Unit LOS
(range)
Mortality (%)              0.03
Fasciotomies (%)           0.003
Complex soft
tissue repairs (%)        <0.0001
Major amputations (%)     <0.0001
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