| Determinants of survival after inferior vena cava trauma. | |
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MedLine Citation:
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PMID: 10515547 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Inferior vena cava (IVC) injuries continue to be associated with mortality rates of 21 to 66 per cent despite advances in prehospital, surgical, and critical care. The purpose of this study was to evaluate outcome of patients with IVC injury after treatment at a major urban trauma center and to identify factors predictive of survival. Between 1989 and 1995, 158 patients presented to the Los Angeles County + University of Southern California Medical Center with IVC injuries. One hundred thirty-six patient records were available for review, and 69 data points were collected and analyzed. Mean age was 26 years (range, 6-54), and 122 (90%) patients were male. Mechanism of injury included gunshot in 88 (65%) patients, stab in 23 (17%) patients, shotgun in 7 (5%) patients, and blunt trauma in 18 (13%) patients. The mean Injury Severity Score was 25. Seventy (52%) patients were hypotensive. Eleven (8%) patients died before surgical intervention, and 25 (18%) patients died before operative repair. Repair (79), ligation (20), or observation (1) was accomplished in 100 (74%) patients. Overall survival was 48 per cent and 65 per cent in the 100 patients surviving to operative repair, including 5 of 20 patients requiring IVC ligation. Significant differences (P<0.001) between survivors and nonsurvivors included Injury Severity Score, Glasgow Coma Score, hematocrit, hypotension, emergent thoracotomy, blood loss, level of injury, tamponade, and associated aortic injury. Logistic regression analysis identified hypotension, anatomic level of injury, and associated aortic injury as significant predictors of outcome (P = 0.001). Survival is predominantly determined by severity and anatomic accessibility of the IVC injury and by the absence of associated major vascular injuries. Ligation may control otherwise exsanguinating injuries and should be considered early in the management of complex injuries. |
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Authors:
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J Kuehne; J Frankhouse; G Modrall; S Golshani; I Aziz; D Demetriades; A E Yellin |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The American surgeon Volume: 65 ISSN: 0003-1348 ISO Abbreviation: Am Surg Publication Date: 1999 Oct |
Date Detail:
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Created Date: 1999-10-21 Completed Date: 1999-10-21 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0370522 Medline TA: Am Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 976-81 Citation Subset: IM |
Affiliation:
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Los Angeles County+University of Southern California Medical Center, Los Angeles 90033, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aorta / injuries California / epidemiology Child Female Glasgow Coma Scale Humans Injury Severity Score Male Middle Aged Survival Analysis Vena Cava, Inferior / injuries*, surgery Wounds and Injuries / mortality, surgery |
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