GCS as a predictor of mortality in patients with traumatic inferior vena cava injuries: a retrospective review of 16 cases

World Journal of Emergency Surgery

Ivette Arriagada¹  Juan P Ramos²  Angelo Fulle²  Michael Cudworth² 

[1] Vascular Surgery, Hospital Dr. Sotero del Rio, Concha y Toro, 3459 Puente Alto, Santiago, Chile;Adult Emergency Services, Surgery, Hospital Dr. Sotero del Rio, Concha y Toro, 3459 Puente Alto, Santiago, Chile

关键词: Injury;    Glasgow;    Inferior vena cava;    Trauma;    Vascular;   

Others  :  791528
DOI  :  10.1186/1749-7922-8-59

 received in 2013-10-01, accepted in 2013-12-26,  发布年份 2013

【 摘 要 】

Introduction

Recent research has determined Glasgow Coma Scale (GCS) to be an independent predictor of mortality in patients with traumatic inferior vena cava (IVC) injuries. The aim of this study was to evaluate the use of GCS, as well as other factors previously described as determinants of mortality, in a cohort of patients presenting with traumatic IVC lesions.

Methods

A 7-year retrospective review was undertaken of all trauma patients presenting to a tertiary care trauma center with trauma related IVC lesions. Factors described in the literature as associated with mortality were assessed with univariate analysis. ANOVA analysis of variance was used to compare means for continuous variables; dichotomous variables were assessed with Fischer’s exact test. Logistic regression was performed on significant variables to assess determinants of mortality.

Results

Sixteen patients with traumatic IVC injuries were identified, from January 2005 to December 2011. Six patients died (mortality, 37.5%); the mechanism of injury was blunt in one case (6.2%) and penetrating in the 15 others (93.7%). Seven patients underwent thoracotomy in the operating room (OR) to obtain vascular control (43.7%). Upon univariate analysis, non-survivors were significantly more likely than survivors to have lower mean arterial pressures (MAP) in the emergency room (ER) (45.6 +/- 8.6 vs. 76.5 +/- 25.4, p = 0.013), a lower GCS (8.1 +/- 4.1 vs. 14 +/- 2.8, p = 0.004), more severe injuries (ISS 60.3 +/- 3.5 vs 28.7 +/- 22.9, p = 0.0006), have undergone thoracotomy (83.3% vs. 16.6%, p = 0.024), and have a shorter operative time (105 +/- 59.8 min vs 189 +/- 65.3 min, p = 0.022). Logistic regression analysis revealed GCS as a significant inverse determinant of mortality (OR = 0.6, 0.46-0.95, p = 0.026). Other determinants of mortality by logistic regression were thoracotomy (OR = 20, 1.4-282.4, p = 0.027), and caval ligation as operative management (OR = 45, 2.28-885.6, p = 0.012).

Conclusions

GCS, the need to undergo thoracotomy, and caval ligation as operative management are significant predictors of mortality in patients with traumatic IVC injuries.

【 授权许可】

   
2013 Cudworth et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Kuehne J, Frankhouse J, Modrall G, Golshani S, Aziz I, Demetriades D: Determinants of survival after inferior vena cava trauma. Am Surg 1999, 65(10):976-981.
• [2]Jackson MR, Olson DW, Beckett WC Jr: Abdominal vascular trauma: a review of 106 injuries. Am Surg 1992, 58:622-626.
• [3]Ombrellaro MP, Freeman MB, Stevens SL, et al.: Predictors of survival after inferior vena cava injuries. Am Surg 1997, 63:178-183.
• [4]Leppaniemi AK, Savolainen HO, Salo JA: Traumatic inferior vena caval injuries. Scand J Thorac 1994, 28:103-108.
• [5]Huerta S, Bui T, Nguyen T, Banimahd F, Porral D: Predictors of mortality and management of patients with traumatic inferior vena cava injuries. Am Surg 2006, 72(4):290-296.
• [6]Burch JM, Feliciano DV, Mattox KL: The atriocaval shunt. Facts and fiction. Ann Surg 1988, 207:555-568.
• [7]Klein SR, Baumgartner FJ, Bongard FS: Contemporary management strategy for major inferior vena caval injuries. J Trauma 1994, 37:35-41.
• [8]Kudsk KA, Bongard F, Lim RX Jr: Determinants of survival after vena caval injury. Analysis of a 14year experience. Arch Surg 1984, 119:1009-1012.
• [9]Rosengart M, Smith D, Melton S, May A: Prognostic factors in patients with inferior vena cava injuries. Am Surg 1999, 65(9):849-856.
• [10]Turpin I, State D, Schwartz A: Injuries to the inferior vena cava and their management. Am J Surg 1977, 134:25-32.
• [11]Wilson RF, Wiencek RG, Balog M: Factors affecting mortality rate with iliac vein injuries. J Trauma 1990, 30:320-323.
• [12]Buckman RF, Pathak AS, Badellino MM, et al.: Injuries of the inferior vena cava. Surg Clin North Am 2001, 81:1431-1447.
• [13]Blaisdell FW, Lim RC Jr: Liver resection. Major Probl Clin Surg 1971, 3:131-145.
• [14]Bricker DL, Morton JR, Okies JE, et al.: Surgical management of injuries to the vena cava: changing patterns of injury and newer techniques of repair. J Trauma 1971, 11:722-735.
• [15]Brown RS, Boyd DR, Matsuda T, et al.: Temporary internal vascular shunt for retrohepatic vena cava injury. J Trauma 1971, 11:736-737.
• [16]Byrne DE, Pass HI, Crawford FA Jr: Traumatic vena caval injuries. Am J Surg 1980, 140:600-602.
• [17]Graham JM, Mattox KL, Beall AC Jr, et al.: Traumatic injuries of the inferior vena cava. Arch Surg 1978, 113:413-418.
• [18]Millikan JS, Moore EE, Cogbill TH, et al.: Inferior vena cava injuries: a continuing challenge. J Trauma 1983, 23:207-212.