P-047 - EPIDEMIOLOGY OF VASCULAR INJURIES AFTER GUN VIOLENCE

TOPIC:
Vascular Trauma
AUTHORS:
Nyberger K. (Karolinska Institute ~ Stockholm ~ Sweden) , Wahlgren C. (Karolinska Institute ~ Stockholm ~ Sweden)
Introduction:
Violence due to firearms is a major global public health issue and frequently contributes to premature deaths. The aim of this study was to analyse nationwide epidemiology of firearm-related vascular injuries.
Methods:
This was a retrospective nationwide epidemiological study including all patients with firearm injuries from the national Swedish Trauma Registry (SweTrau) from January 1, 2011 to December 31, 2019. There were 71879 trauma patients registered during the study period, of which 1010 patients were identified with firearm injuries (1.4%).
Results:
There were 162 patients admitted with 238 firearm-related vascular injuries, 96.9% men (n=157) and 3.1% women (n=5), median age 26.0 years [IQR 22-33]. The most common anatomical vascular injury location was lower extremity (41.7%) followed by abdomen (18.9%), and chest (18.9%). The dominating vascular injuries were: common femoral artery (17.6%, 42/238), iliac arteries (7.1%, 17/238), superficial femoral artery (7.1%, 17/238), and thoracic aorta (6.7%, 16/238). About one third of patients (36.4%, 59/162) had multiple vascular injuries, and 8.6% (14/162) had multiple vascular injuries in more than one anatomic injury location. There were 125 registered vascular surgery procedures including bypass 24.8% (31/125) and direct vascular repair 18.4% (23/125). Endovascular stentgraft was placed in seven patients (5.6%). The 30-day and 90-day mortality was 29.9% (50/162) and 33.3% (54/162), respectively. The majority of deaths (79.6%; 43/54) was within 24-h of injury. In the mortality group, vascular injuries to the thoracic aorta (27.8%, 15/54) followed by femoral (16.7%, 9/54) and carotid artery (13.0%, 7/54) were most common. In the multivariate regression analysis, vascular injury to chest (P<0.001) or abdomen (P=0.002) was associated with 24-h mortality. Injury specifically to thoracic aorta (P<0.001) or femoral artery (P=0.022) was associated with 24-h mortality as well.
Conclusion:
Firearm-related vascular injuries caused significant morbidity and mortality. The lower extremity was the most common injury location but vascular injuries to chest and abdomen most lethal. Injuries to the thoracic aorta and the femoral arteries were specifically associated with early mortality. Improved management strategies for better outcome are critical.