GCS as a predictor of mortality in patients with traumatic inferior vena cava injuries: a retrospective review of 16 cases

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Abstract

Introduction

Recent research has determined Glasgow Coma Scale (GCS) to be an independent predictor of mortality in patients with traumatic inferior vena cava (IVC) injuries. The aim of this study was to evaluate the use of GCS, as well as other factors previously described as determinants of mortality, in a cohort of patients presenting with traumatic IVC lesions.

Methods

A 7-year retrospective review was undertaken of all trauma patients presenting to a tertiary care trauma center with trauma related IVC lesions. Factors described in the literature as associated with mortality were assessed with univariate analysis. ANOVA analysis of variance was used to compare means for continuous variables; dichotomous variables were assessed with Fischer’s exact test. Logistic regression was performed on significant variables to assess determinants of mortality.

Results

Sixteen patients with traumatic IVC injuries were identified, from January 2005 to December 2011. Six patients died (mortality, 37.5%); the mechanism of injury was blunt in one case (6.2%) and penetrating in the 15 others (93.7%). Seven patients underwent thoracotomy in the operating room (OR) to obtain vascular control (43.7%). Upon univariate analysis, non-survivors were significantly more likely than survivors to have lower mean arterial pressures (MAP) in the emergency room (ER) (45.6 +/- 8.6 vs. 76.5 +/- 25.4, p = 0.013), a lower GCS (8.1 +/- 4.1 vs. 14 +/- 2.8, p = 0.004), more severe injuries (ISS 60.3 +/- 3.5 vs 28.7 +/- 22.9, p = 0.0006), have undergone thoracotomy (83.3% vs. 16.6%, p = 0.024), and have a shorter operative time (105 +/- 59.8 min vs 189 +/- 65.3 min, p = 0.022). Logistic regression analysis revealed GCS as a significant inverse determinant of mortality (OR = 0.6, 0.46-0.95, p = 0.026). Other determinants of mortality by logistic regression were thoracotomy (OR = 20, 1.4-282.4, p = 0.027), and caval ligation as operative management (OR = 45, 2.28-885.6, p = 0.012).

Conclusions

GCS, the need to undergo thoracotomy, and caval ligation as operative management are significant predictors of mortality in patients with traumatic IVC injuries.

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Most cited references 17

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Predictors of mortality and management of patients with traumatic inferior vena cava injuries.

Thi Nguyen, Matthew Dolich, Diana Porral … (2006)

The aim of this study was to determine factors that predict mortality in patients with traumatic inferior vena cava (IVC) injuries and to review the current management of this lethal injury. A 7-year retrospective review of all trauma patients with IVC injuries was performed. Factors associated with mortality were assessed by univariate analysis. Significant variables were included in a multivariate regression analysis model to determine independent predictors of mortality. Statistical significance was determined at P < or = 0.05. A literature review of traumatic IVC injuries was performed and compared with our institutional experience. Thirty-six IVC injuries were identified (mortality, 56%; mechanisms of injury, 28% blunt and 72% penetrating). There was no difference in mortality based on mechanism of injury. Injuries with closer proximity to the heart were associated with increased mortality (P < 0.001). Univariate analysis demonstrated that nonsurvivors had a higher injury severity scale, a lower systolic blood pressure in the emergency department, a lower Glasgow coma score (GCS), and were more likely to have thoracotomies performed in the emergency department or operating room. Multivariate analysis revealed that only GCS (P = 0.03) was an independent predictor of mortality. Typical factors predicting mortality were identified in our cohort of patients, including GCS. The mechanism of injury is not associated with survival outcome, although mortality is higher with injuries more proximal to the heart. The form of management by IVC level is reviewed in our patient population and compared with the literature.

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Abdominal vascular trauma: a review of 106 injuries.

Nathan Olson, Elizabeth J. Robertson, Anne S B Olsen … (1992)

A retrospective analysis of acute abdominal vascular injuries was performed to review outcome variables and treatment principles. The authors review their most recent 5-year experience with 106 major abdominal vascular injuries in 64 patients treated at a combined Army and Air Force urban medical center. The majority of the patients were young men who sustained penetrating injuries. There were 41 (64%) gunshot wounds, 17 (27%) stab wounds, and 6 (9%) sustained blunt trauma. Forty-five patients (71%) came to the hospital in shock. The inferior vena cava in 26 patients (41%) and the aorta in 11 patients (17%) were injured most frequently. Suture repair was possible in 53 (50%) injuries. Ligation was performed in 41 (39%). Overall mortality for the series was 39 per cent. Hemorrhagic shock was the cause of death in 23 patients (92%) with only two late deaths. Transfusion requirement, presence of shock, and number of vessels injured all affected outcome. Immediate stabilization in the emergency department includes appropriate crystalloid and blood product resuscitation with minimal delay for diagnostic studies. Prompt abdominal exploration to control hemorrhage and particular attention to factors associated with coagulopathy remain the key elements in saving the lives of these severely injured patients.

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The atriocaval shunt. Facts and fiction.

J Burch, K Mattox, Philip Feliciano (1988)

During the past 11 years, 31 patients with major juxtahepatic venous injuries were treated with the atriocaval shunt. Penetrating injuries occurred in 27 patients (87%), and injuries from blunt trauma occurred in four patients. Shock was present on admission in 28 patients (90%). Resuscitative thoracotomy for cardiovascular collapse was required in 13 patients (42%). Juxtahepatic venous injuries included the vena cava in 23 patients (74%) and the hepatic veins alone in five patients (16%). One patient had an isolated portal venous injury, and two patients died before their vascular injuries could be delineated. Technical problems related to the shunt occurred in seven patients. Most were related to delays in placement or problems encountered in obtaining vascular control of the suprarenal vena cava. Major hepatic resection was performed in 11 patients (35%). Twenty-five patients died of their injuries. No patient survived who required resuscitative thoracotomy, hepatic resection, or when technical problems with the shunt occurred. Six patients (19%) survived and were discharged from the hospital. All sustained gunshot wounds to the retro-hepatic vena cava. Four of the six survivors had serious postoperative complications, but none were related to the shunt. Major juxtahepatic venous injuries are highly lethal. The atriocaval shunt will permit the salvage of some patients where other methods are not possible. Avoidance of delay and alternative shunting techniques that eliminate difficult maneuvers may improve survival in the future.

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Author and article information

Journal

Journal ID (nlm-ta): World J Emerg Surg

Journal ID (iso-abbrev): World J Emerg Surg

Title: World Journal of Emergency Surgery : WJES

Publisher: BioMed Central

ISSN (Electronic): 1749-7922

Publication date Collection: 2013

Publication date (Electronic): 29 December 2013

Volume: 8

Page: 59

Affiliations

[1 ]Adult Emergency Services, Surgery, Hospital Dr. Sotero del Rio, Concha y Toro, 3459 Puente Alto, Santiago, Chile

[2 ]Vascular Surgery, Hospital Dr. Sotero del Rio, Concha y Toro, 3459 Puente Alto, Santiago, Chile

Article

Publisher ID: 1749-7922-8-59

DOI: 10.1186/1749-7922-8-59

PMC ID: 3895755

PubMed ID: 24373210

SO-VID: f90a14ac-fbf7-4da6-8bdd-b19c21b7c390

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

GCS as a predictor of mortality in patients with traumatic inferior vena cava injuries: a retrospective review of 16 cases

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Abstract

Introduction

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Most cited references 17

Predictors of mortality and management of patients with traumatic inferior vena cava injuries.

Abdominal vascular trauma: a review of 106 injuries.

The atriocaval shunt. Facts and fiction.

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