Predictors of Mortality and Management of Patients with Traumatic Inferior Vena Cava Injuries

Abstract

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 ≤ 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 non-survivors 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.

Basic data underlying clinical decision‐making and outcomes in emergency department thoracotomy: tabular review

“…Of 15 papers reporting neurological outcomes, 84.6% (143 of the 169, range 50–100%) of patients returned to baseline . The survival outcome of EDT in US experience versus non‐US experiences was 6.3% (164 of the 2612, range 0–14.9) versus 11.9% (89 of the 745, range 0–33.3) respectively. Papers reporting outcomes of EDT performed in the pre‐hospital setting had survival rate of 16.3% (19 of the 116, range 10.25–33.33%) while those performed in the military had survival rate of 11.9% (13 of the 109, range 11.9–12.5%) …”

“…We identified 37 papers with a total of 3466 patients (Table ) . The overall incidence of patients undergoing EDT for penetrating trauma was 85.2% (1720 of the 2018, range 40–100%) .…”

A Rare Case of Survival from Inferior Vena Cava Injury

“…The decrease in mortality rates in patients with abdominal IVC injuries has only been marginal over the past many decades. While 30% to 50% of cases with IVC injury exsanguinate to death before reaching the hospital, another 50% die despite the maximal possible hospital care [3]. Multiple factors predict the outcome of the patient in IVC injuries, including the mechanism of trauma, systolic blood pressure on presentation, response to resuscitation, part of IVC injured, and concomitant solid organ and vascular injuries [4,5].…”

“…Multiple cases have been reported where exploration of retroperitoneum started torrential bleed by removal of the tamponade effect of hematomas and death of a patient on table [2]. A study done by Huerta and Nguyen showed that 40% of the patients died of uncontrollable bleeding after the tamponade effect was released [3]. Hence, exploration or no exploration remains debatable.…”

“…However, among the abdominal vessels, it is the most commonly injured vessel in trauma, accounting for 25% of the abdominal vascular injuries [2]. In the case of firearm injuries of the abdomen, one in 50 bullets strikes the IVC [3]. Despite all the advancements in perioperative services, mortality remains exceptionally high, reported up to 65% in IVC injuries [4].…”