P-048 - CIVILIAN VASCULAR TRAUMA AT A NORTH-EUROPEAN LEVEL 1-TRAUMA CENTRE; INCIDENCE, TREATMENT AND OUTCOME

TOPIC:
Vascular Trauma
AUTHORS:
Johannesdottir B. (Haukeland University Hospital ~ Bergen ~ Norway) , Geisner T. (Haukeland University Hospital ~ Bergen ~ Norway) , Gubberud E. (Haukeland University Hospital ~ Bergen ~ Norway) , Gudbjartsson T. (Landspitali University Hospital, University of Iceland ~ Reykjavik ~ Iceland)
Introduction:
In most developed countries, trauma is one of the leading causes of death in all age groups. Vascular injuries may be responsible for up to 20% of trauma deaths. Outcomes after vascular injuries in wartime are well documented, but studies on vascular injuries in the civilian Nordic populations are scarce.
Methods:
A retrospective study on all adults admitted to the at a European level 1-trauma centre 2009-2018 with AIS-codes for non-iatrogenic vascular trauma. Data were extracted from a national and local trauma-registry as well as patient charts. Patient demographics, mechanism, and location of vascular injury were registered together with treatment given. Incidence and injury scores (ISS, NISS and TRISS) were calculated and overall survival (Kaplan-Meier) estimated.
Results:
Of 4,042 trauma-patients, 68 (1.7%) (mean (IQR) age 44 (31-60) years, 76% male) sustained 81 vascular injuries (69 arterial; 12 venous); 46 being blunt and 22 (32%) penetrating. The incidenc of vascular injurie was 1.45/100,000 inhabitants (95% confidence interval: 1.13-1.82) and did not changes significantly over the study-period (p = 0.483). The injuries were located in the thorax (n = 17), neck (n = 16) and the abdominal region (n = 15); most of the blunt injuries following traffic (n = 31) or falling accidents (n=10), and 17 of the 22 penetrating injuries due to stabbing. The median ISS and NISS-scores (IQR) were 22 (14-36) and 33 (17-46), with 50 (74%) and 55 (81%) patients having scores >15, respectively. Forty-three patients had surgical repair, 8 received endovascular-stent, 4 died before reaching the operative room and 16 patients were treated conservatively. Twenty-one patients died <30-days (31%), 33% and 27% after blunt and penetrating injuries, respectively. Half of the patients that died <24 hrs. sustained aortic injury.
Conclusion:
Traumatic vascular injury is rare in civilian settings and only accounted for 1.7% of patients admitted for serious trauma. Still, these patients are seriously injured and their treatment challenging, which is reflected in their high 30-day mortality (31%).