Abdominal vascular trauma in 760 severely injured patients
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ORIGINAL ARTICLE
Abdominal vascular trauma in 760 severely injured patients M. Heuer • B. Hussmann • G. M. Kaiser R. Lefering • A. Paul • S. Lendemans • The Trauma Registry of the DGU
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Received: 27 June 2012 / Accepted: 7 October 2012 / Published online: 2 November 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose The relevance of abdominal vascular injuries in polytraumatic patients within a large collective has not yet been thoroughly analyzed. This study aimed at assessing the prevalence of traumatic injuries in relation to outcome and currently established treatment options. Methods 51,425 patients from the Trauma Registry of the German Society of Trauma Surgery (TR DGU) (1993–2009) were analyzed retrospectively. All patients who had an Injury Severity Score (ISS) of C16, were directly admitted to a trauma center and subsequently received treatment for at least three days, were C16 years old, and had an abdominal injury (AISabdomen C2) were included. Patients with abdominal trauma (AISabdomen C2) were compared with patients with additional vascular trauma (AISvascular 2–5).
M. Heuer (&) G. M. Kaiser A. Paul Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, NRW, Germany e-mail: [email protected] B. Hussmann S. Lendemans Department of Trauma Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, NRW, Germany e-mail: [email protected] R. Lefering Faculty of Medicine, Institute for Research in Operative Medicine, University of Witten/Herdecke, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109 Cologne, NRW, Germany The Trauma Registry of the DGU German Society for Trauma Surgery (DGU), Committee on Emergency Medicine and Intensive Care, Berlin, Germany
Results 10,530 (20.5 %) of the 51,425 patients had documented abdominal injury. 760 (7.2 %) of the patients with abdominal injury additionally showed abdominal vascular injury (AISabdomen C2, AISvascular 2–5) and were analyzed based on the classification of the American Association for the Surgery of Trauma (AAST) organ severity score (AAST vascular injury grade: II, 2.4 %; III, 2.7 %; IV, 1.8 %; V, 0.2 %. Patients with high-grade abdominal vascular injury (grades IV and V) showed a significant increase in mortality (IV, 44.6 %; V, 60 %) and consequently a decrease in the need for surgical intervention (IV, 67.4 %; V, 64 %). Conclusions The results presented here show the prevalence and outcome of abdominal vascular injuries in a large collective within the TR DGU for the first time. Based on the current literature and these findings, a treatment algorithm has been developed. Keywords Trauma Abdomen Vascular injury Mortality Prognosis
Introduction Polytraumatic patients with abdominal vascular injuries following blunt or penetrating trauma are part of the injury pattern in around 0.5–5 % of documented cases [1, 2]. In industrialized countries, these injuries are mostly caused by a blunt accident mechanism [3]. In 30–40 % of t
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