THE BURDEN OF VASCULAR INJURIES ON A TRAUMA CENTER STILL
REQUIRES A MULTI-SPECIALTY APPROACH
Jack C. He, MD1, Kate Clancy, BS2, David Schechtman, BS2, Jeffrey A. Claridge, MD, MS,
FACS1
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School
of Medicine, Cleveland, OH 44109, USA
2
Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
Background
Although vascular traumas account for only a small proportion of traumas, they are associated
with 25% of early trauma deaths. The management of vascular injuries is complex, technically
demanding, and often requires emergent operative intervention. Currently, traumatic vascular
injuries across the U.S. are treated by surgeons with various backgrounds including trauma,
vascular, plastic, or hand surgery. From a staffing perspective, it is important to understand the
vascular expertise needed when managing a trauma center. Lack of vascular “coverage”,
availability, or experience is often a reason for hospitals to transfer patients.
Objectives:
This study aims to investigate the incidence and burden of vascular injury at a level I regional
trauma hospital and to characterize the need for vascular surgery in operative management of
these injuries.
Methods and Patients:
Adult trauma patients with age 14 or greater, who were treated at MetroHealth Medical Center, a
regional level I trauma center, for traumatic vascular injuries that occurred from January 1, 2008
to December 31, 2013 were included in this retrospective study. Patients were identified using
International Classification of Diseases codes 900 to 904 to capture head/neck, thoracic,
abdominal, and upper/lower extremity vascular injuries. Data collected include age, sex, race,
trauma mechanism, trauma type (blunt versus penetrating), type of vascular injury, injury
severity score (ISS), presence of operative repair by vascular surgery and operative team
specialty. Data were analyzed using IBM SPSS ©, version 22 (IBM, Armonk, NY). Numerical
data were compared using the Student’s t-test. Categorical data were compared using either the
Chi-squared test or Fisher’s exact test. A p-value of less than or equal to 0.05 was considered
statistically significant.
Results:
From 2008 to 2013, 27,224 trauma patients with age 14 or greater were treated at MetroHealth
Medical Center. 385 (1.4%) patients needed operative intervention for their acute vascular
injuries. Two patients were excluded due to insufficient data from medical record, yielding 383
patients for analysis. The mean age for this group was 34 ± 15; 84% were male; the mean ISS
was 14 ± 12. 57% of these patients were managed operatively by trauma staff.
From the overall analysis group, we were specifically interested in evaluating the 239 patients
with penetrating vascular injuries that required operative repair after excluding isolated
hand/forearm injuries (Figure 1). The breakdown of these patients by body region is shown in
Dr. Jack C He
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Table 1. The mean age of this group was 31 ± 12 and 90% were male. 40% of their injuries
needed operative intervention by vascular surgery, and 7.6% required treatment by other surgical
subspecialties.
There was significant variability in the need for vascular surgery based on trauma staff practice
and injured body region (Table 1). There was minimal difference in the percentage of patients
who required vascular surgery intervention based on year, day of week, month or patient
demographics and admission vital signs.
Conclusion:
Approximately 14 patients for every 1000 trauma patients treated will require a vascular
operative intervention. Most of them were treated by trauma surgery staff alone; however, a
significant portion of these patients still requires additional operative treatment from vascular or
other surgical subspecialties. These data are important as one evaluates resource needs for a
trauma center.
Figure 1
Dr. Jack C He
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Table 1
Operations
Involving Vascular
Surgery
100
Overall
Trauma Staff Practice Preference
Staff 1
3
Staff 2
10
Staff 3
21
Staff 4
10
Staff 5
21
Staff 6
5
Staff 7
6
Staff 8
21
* Staff with < 5 cases were not included in analysis
Total
Body Region
Head/Neck
Thoracic
Abdomen/Pelvis
Upper Extremity
Lower Extremity
Operations
Involving Vascular
Surgery
103
Number Patients
238
Percent
42%
12
47
52
13
40
15
21
32
25%
21%
40%
77%
53%
33%
29%
66%
Number of Operations
243
Percent
42%
pvalue
0.001
pvalue
0.001
9
6
21
16
51
28
20
65
38
92
Dr. Jack C He
Room H939, Hamann Bldg
2500 MetroHealth Dr. Cleveland, OH 44109
Telephone: (630) 631-9411 Fax: (216) 778-5616
jhe@metrohealth.org
32%
30%
32%
42%
55%