Contemporary management and prognosis of great vessels trauma |
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| Institution: | 1. Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan;2. Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan;1. ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department Trauma TopCare, Tilburg, the Netherlands;2. Erasmus MC University Medical Centre, Department of Public Health, Rotterdam, the Netherlands;3. Erasmus MC University Medical Centre, Department of Emergency Medicine, Rotterdam, the Netherlands;4. Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, the Netherlands;1. Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand;2. Musculoskeletal Science and Translational Research Center (MSTR), Chiang Mai University, Chiang Mai, 50200, Thailand;1. Specialty Registrar – Trauma & Orthopaedics, University Hospitals of Leicester, Gwendolen Road, Leicester, LE5 4PW, United Kingdom;2. Professor of Orthopaedics and Hand Surgery, University Hospitals of Leicester, United Kingdom;1. Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, United States;2. School of Public Health, Oregon Health & Science University, Portland, Oregon, United States;3. Department of Surgery, University of Washington, Seattle, Washington, United States;4. Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, United States;5. Center for Health Systems Effectiveness, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, United States;6. Department of Internal Medicine, Division of Geriatrics, Oregon Health & Science University, Portland, Oregon, United States |
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| Abstract: | BackgroundGreat vessel trauma (GVT), which is defined as trauma to the aorta or vena cava, remains one of the most challenging injuries to treat and has a high mortality rate despite advances in modern medicine. Additionally, the optimal management of GVT is controversial. In this study, we review the incidence, management, and outcome of GVT, identify the current status and prognostic factors of GVT, and compare treatment outcomes.MethodsWe conducted a retrospective, single-center, cohort study of patients with GVT in a Level I trauma center from August 2008 to December 2013. We retrieved demographic data, physical and imaging findings, injury severity score (ISS), treatment choice, length of hospital stay, and mortality. We analyzed the risks of adverse outcomes and mortality.ResultsThe seventy-four patients in this cohort had a mean age of 41.6 (SD 17.7) years and a high mortality rate of 27%. The prognostic factors of survival with GVT included male gender, lower ISS, higher GCS, higher SBP and DBP and vena caval injuries. We also determined that vena caval injury is the main factor that can predict mortality.ConclusionIn conclusion, GVT is relatively rare but often lethal in clinical practice. Patient survival depends on injury severity and the shock status grade. Aggressive resuscitation and treatment play important roles in survival. The coordination of different levels of surgical expertise and the application of novel treatment methods are required to improve clinical outcomes for patients with vena caval injuries. |
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| Keywords: | Great vessel injury Trauma Aortic trauma Vena caval trauma |
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