title: Vascular injuries in a rural state: a review of 978 patients from a state trauma registry.
abstract: The demographics, etiology, and outcome of 1148 vascular injuries suffered by 978 patients reported from eight trauma centers in a largely rural state to a trauma registry (NCTR) data base containing 26,617 patients entered over a 39-month time interval were analyzed. Vascular injury patients were more frequently transferred by helicopter (18%), referred from other hospitals (45%), transfused more blood (8 units mean/24 hours), had higher mean ISS values (14 vs. 9), had lower systolic blood pressures on admission (113 vs. 128 mm Hg), had higher emergency department mortality (3.3%), and required immediate surgery more often (79%) when compared with nonvascular injury NCTR patients (p = 0.0001). Vascular injury patients had significantly longer hospital stays (13 vs. 10 days), longer ICU stays (5 vs. 4 days), and greater hospital costs ($22,500 vs. $12,300) while incurring more serious AIS values for the regions of the chest, abdomen, and extremities. One hundred twenty-nine (13.1%) died, 97 after admission compared with a 6.2% mortality for NCTR nonvascular injury victims. Forty-seven percent of vascular injuries were extremity lesions; the amputation rate was 1.3%; and management was most often by simple repair (41.9%) or patching (22.2%). Rural vascular injury patients had a high incidence of blunt trauma (43.4%) and were older (average, 51 years); they were transported by helicopter more often (30.3%) and were frequently referred from another hospital (77.8%); they had longer ICU, ventilator, and hospital stays and greater hospital charges; and they had higher mortality (14.2%) compared with urban vascular trauma victims. The data suggest a need for the trauma care system to focus on earlier recognition, stabilization, and rapid transportation of this most seriously injured group of patients.
authors.affiliation: University of North Carolina, Raleigh.
authors.forename: D W
authors.initials: DW
authors.lastname: Oller
authors.forename: R
authors.initials: R
authors.lastname: Rutledge
authors.forename: T
authors.initials: T
authors.lastname: Clancy
authors.forename: P
authors.initials: P
authors.lastname: Cunningham
authors.forename: M
authors.initials: M
authors.lastname: Thomason
authors.forename: W
authors.initials: W
authors.lastname: Meredith
authors.forename: J
authors.initials: J
authors.lastname: Moylan
authors.forename: C C
authors.initials: CC
authors.lastname: Baker
mesh_terms: D000367:Age Factors; D000401:Aircraft / Q000706:statistics & numerical data; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001808:Blood Vessels / Q000293:injuries*; D004630:Emergencies; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012424:Rural Population; D015996:Survival Rate; D014193:Trauma Centers; D014505:Urban Population; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy