Contemporary Management and Outcomes of Injuries to the Inferior Vena Cava: A Prospective Multicenter Trial From PROspective Observational Vascular Injury Treatment

Stonko, David P.; Azar, Faris; Betzold, Richard; Morrison, Jonathan J.; Fransman, Ryan; Holcomb, John B.; Bee, Tiffany K.; Fabian, Timothy C.; Skarupa, David; Stein, Deborah M.; Kozar, Rosemary A.; O’Connor, James V.; Scalea, Thomas M.; DuBose, Joseph J.; Feliciano, David V.

doi:10.1177/00031348211038556

Cited by 12 publications

(9 citation statements)

References 18 publications

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“…Other datasets such as the PROspective Observation Vascular Injury and Treatment (PROOVIT) registry may be useful for this type of analysis in the future, or for looking more closely as injury type: such as how do the management strategies or outcomes between transection versus partial transection versus occlusion differ. (42) In addition, there is no information regarding follow-up and long-term outcomes including functional outcomes. Similarly, this may also be useful for comparing how outcomes compares across repair type, such as vein or synthetic graft interposition, or type of endovascular intervention (e.g., stent, embolization, etc.).…”

Section: Discussionmentioning

confidence: 99%

Contemporary management and time to revascularization in upper extremity arterial injury

et al. 2022

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Introduction Upper extremity arterial injury is associated with significant morbidity and mortality for trauma patients, but there is a paucity of data to guide the clinician in the management of these injuries. The goals of this review were to characterize the demographics, presentation, clinical management, and outcomes, and to evaluate how time to intervention associates with outcomes in trauma patients with upper extremity vascular injuries. Methods The National Trauma Data Bank (NTDB) Research Data Set for the years 2007–2016 was queried in order to identify adult patients (age ≥ 18) with an upper extremity arterial injury. Patients with brachiocephalic, subclavian, axillary, or brachial artery injury using the 1998 and 2005 versions of the Abbreviated Injury Scale were included. Patients with non-survivable injuries to the brain, traumatic amputation, or other major arterial injuries to the torso or lower extremities were excluded. Results The data from 7908 patients with upper extremity arterial injuries was reviewed. Of those, 5407 (68.4%) underwent repair of the injured artery. The median Injury Severity Score (ISS) was 10 (IQR = 7–18), and 7.7% of patients had a severe ISS (≥ 25). Median time to repair was 120 min (IQR = 60–240 min). Management was open repair in 52.3%, endovascular repair in 7.3%, and combined open and endovascular repairs in 8.8%; amputation occurred in 1.8% and non-operative management was used in 31.6% of patients. Blunt mechanism of injury, crush injury, concomitant fractures/dislocations, and nerve injuries were associated with amputation, whereas simultaneous venous injury was not. There was a significant decrease in the rate of amputation when patients undergoing surgical revascularization did so within 90 min of injury (P = 0.007). Conclusion Injuries to arteries of the upper extremity are managed with open repair, endovascular repair, and, rarely, amputation. Expeditious transport to the operating room for revascularization is the key for limb salvage.

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Section: Discussionmentioning

confidence: 99%

Contemporary management and time to revascularization in upper extremity arterial injury

et al. 2022

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“…With regards to outcomes, the PROOVIT database is limited to the acute setting and evaluation of in-hospital complications and mortality. 17,19,26 There is certainly need for additional research into the long-term use of AC and AP for management after repair of a vascular injury, but that is beyond the scope of this analysis. This work may help guide AT therapy choice during the acute peri-trauma period, and future studies may help guide the management in the long term.…”

Section: Discussionmentioning

confidence: 99%

“…The American Association for the Surgery of Trauma (AAST) PROOVIT registry is a AAST Multicenter Trial that enrolls patients with injuries to named arterial and venous structures. 13,17,18,19 This database captures patient demographics, admission physiologic data, detailed information on the type and management of vascular injuries, and any data on imaging from the vascular laboratory. Patients are included if >2 years old with imaging, clinical, and/or operative evidence of injury to a named vessel.…”

Section: Characteristics Of Cohortmentioning

confidence: 99%

Postoperative antiplatelet and/or anticoagulation use does not impact complication or reintervention rates after vein repair of arterial injury: A PROOVIT study

et al. 2022

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Introduction The use of antiplatelet (AP) and anticoagulation (AC) therapy after autogenous vein repair of traumatic arterial injury is controversial. The hypothesis in this study was that there is no difference in early postoperative outcomes regardless of whether AC, AP, both, or neither are used. Methods The American Association for the Surgery of Trauma (AAST) PROspective Observational Vascular Injury Treatment (PROOVIT) registry was queried from November, 2013, to January, 2019, for arterial injuries repaired with a vein graft. Demographics and injury characteristics were compared. Need for in-hospital reoperation was the primary outcome in this four-arm study, assessed with two ordinal logistic regression models (1. no therapy vs. AC only vs. AC and AP; 2. no therapy vs. AP only vs. AC and AP). Results 373 patients (52 no therapy, 88 AP only, 77 AC only, 156 both) from 19 centers with recorded Injury Severity Scores (ISS) were identified. Patients who received no therapy were younger than those who received AP (27.0 vs. 34.2, p = 0.02), had higher transfusion requirement ( p < 0.01 between all groups) and a different distribution of anatomic injury ( p < 0.01). After controlling for age, sex, ISS, platelet count, hemoglobin, pH, lactate, INR, transfusion requirement and anatomic location, there was no association with postoperative medical therapy and in-hospital operative reintervention, or any secondary outcome, including thrombosis ( p = 0.67, p = 0.22). Conclusions Neither AC nor AP alone, nor in combination, impact complication rate after arterial repair with autologous vein. These patients can be safely treated with or without antithrombotics, recognizing that this study did not demonstrate a beneficial effect.

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“…While specificity and predictive value are high in this patient population and geography, performance of this study at a single level 1 urban center study with a high percentage of penetrating trauma that may make these results less generalizable to other centers, though this limitation may be improved with the inclusion of more patients and broadening the model to include institutional factors. [45][46][47][48][49][50] Our choice to use final-coded AIS scores as present (by design) in the trauma registry database as proxy indicators for admission diagnostic data introduces a degree of retrospective bias into the network, potentially exaggerating the precision of the predictive values reported. We felt this was the most appropriate and expedient source of data for this proof of concept study in this population, however, as our selection criteria for patients with an at least two-midnight stay limits the study to a subpopulation in which confirmed diagnostic changes to the admission information (e.g.…”

Section: Discussionmentioning

confidence: 99%

A Pilot Machine Learning Study Using Trauma Admission Data to Identify Risk for High Length of Stay

et al. 2022

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Introduction Trauma patients have diverse resource needs due to variable mechanisms and injury patterns. The aim of this study was to build a tool that uses only data available at time of admission to predict prolonged hospital length of stay (LOS). Methods Data was collected from the trauma registry at an urban level one adult trauma center and included patients from 1/1/2014 to 3/31/2019. Trauma patients with one or fewer days LOS were excluded. Single layer and deep artificial neural networks were trained to identify patients in the top quartile of LOS and optimized on area under the receiver operator characteristic curve (AUROC). The predictive performance of the model was assessed on a separate test set using binary classification measures of accuracy, precision, and error. Results 2953 admitted trauma patients with more than one-day LOS were included in this study. They were 70% male, 60% white, and averaged 47 years-old (SD: 21). 28% were penetrating trauma. Median length of stay was 5 days (IQR 3-9). For prediction of prolonged LOS, the deep neural network achieved an AUROC of 0.80 (95% CI: 0.786-0.814) specificity was 0.95, sensitivity was 0.32, with an overall accuracy of 0.79. Conclusion Machine learning can predict, with excellent specificity, trauma patients who will have prolonged length of stay with only physiologic and demographic data available at the time of admission. These patients may benefit from additional resources with respect to disposition planning at the time of admission.

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Contemporary Management and Outcomes of Injuries to the Inferior Vena Cava: A Prospective Multicenter Trial From PROspective Observational Vascular Injury Treatment

Cited by 12 publications

References 18 publications

Contemporary management and time to revascularization in upper extremity arterial injury

Contemporary management and time to revascularization in upper extremity arterial injury

Postoperative antiplatelet and/or anticoagulation use does not impact complication or reintervention rates after vein repair of arterial injury: A PROOVIT study

A Pilot Machine Learning Study Using Trauma Admission Data to Identify Risk for High Length of Stay

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