Scientific paperOperative management and outcome of 302 abdominal vascular injuries
Section snippets
Methods
Over a 72-month period (January 1992 to December 1997) all patients admitted to the Los Angeles County–University of Southern California (LAC+USC) Medical Center, with a proven abdominal vascular injury were retrospectively reviewed and data entered into a collection sheet. Data collected included demographics, such as gender, age, mechanism of injury, admission vital signs, Revised Trauma Score (RTS), and Injury Severity Score (ISS). All abdominal vascular injuries were graded utilizing the
Results
Over the span of the 72-month study (January 1992 to December 1997) there were 302 patients admitted with abdominal vascular injuries. Their mean age was 28 (SD ± 11). The breakdown according to gender included a total of 276 males (91%) and 26 females (9%). There were 266 patients (88%) admitted with penetrating injuries: 216 (81%) sustained gunshot wounds, 46 (17%) sustained stab wounds, and 4 (2%) sustained shotgun wounds. Thirty-six (12%) were admitted with blunt trauma: 23 (64%) were
Comments
Abdominal vascular injuries are amongst the most lethal injuries encountered by modern day trauma surgeons. Many patients arrive with severe physiological compromise secondary to massive blood losses and great number of associated injuries.1, 2, 3, 4, 5, 6, 7 The incidence of abdominal vascular injury varies depending on the setting. During World War II, DeBakey and Simeone10 reported 49 abdominal vascular injuries in 2,471 patients for an incidence of 2%. Hughes11 reported seven iliac artery
Discussion
Dr. Kenneth L. Mattox (Houston, TX): It is altogether appropriate for centers with large volumes to attempt to push the therapeutic envelope, analyze their results and recommend appropriate changes to both themselves and to the world.
It is very clear that Dr. Asensio’s data supports the following three conclusions: One: The AAST-OIS injured grading documents that very sick patients have bad numbers. However, this review begs that the AAST-OIS be revised to upgrade entries to the Iliac artery,
Closing
Dr. Juan Asensio: There is, indeed, data from our institution that reported that patients brought in by EMS personnel did have higher mortality. That study, in which I did not participate, had a small number of these patients.
The vast majority of our patients were actually brought in by EMS. In reviewing the literature as well as our results, you’ll find that even though we have a 15-minute rule in L.A. County to transport these patients promptly to the operating room, one finds that actual
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