title: Practical application of bedside diagnostics in determining limb viability.
abstract: BACKGROUND
  This study aimed to determine the practical application of vascular lab studies in determining limb salvage outcomes in injured patients with concerning clinical examinations.
  
  
  METHODS
  A retrospective review of the trauma registry at a level I center was conducted from January 2009 to June 2013. All patients >16 years of age who sustained a lower limb arterial injury had a concerning clinical exam (mottled skin, decreased skin warmth, diminished pulses) and had vascular lab studies to determine management were included. Data-points included demographics, type and location of injury, procedure type, vascular lab study results, and limb outcome.
  
  
  RESULTS
  Over a five-year period, 11 trauma patients met inclusion criteria. Five of these patients had concerning clinical exams after revascularization, and six observed patients had a concerning clinical examination during the course of their hospitalization. All 11 patients had vascular lab studies that were within normal limits. As a result of normal vascular lab studies, none of these patients underwent further imaging or intervention. None of these patients underwent amputation.
  
  
  CONCLUSIONS
  Vascular lab studies may be utilized to determine the need for intervention and/or lower limb bypass sufficiency in patients with questionable clinical examinations post injury.
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA Center for Translational Injury Research (CeTIR), Department of Surgery, University of Houston-Texas, Houston, TX, USA Andua@mcw.edu.
authors.forename: Anahita
authors.initials: A
authors.lastname: Dua
authors.affiliation: Department of Cardiovascular and Vascular Surgery, University of Houston-Texas, Houston, TX, USA.
authors.forename: Sapan S
authors.initials: SS
authors.lastname: Desai
authors.affiliation: Department of Cardiovascular and Vascular Surgery, University of Houston-Texas, Houston, TX, USA.
authors.forename: Sheila
authors.initials: S
authors.lastname: Coogan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000175:diagnosis* / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000175:diagnosis* / Q000601:surgery*; D055815:Young Adult
keywords: Limb salvage; ankle-brachial indices; ankle-brachial pressure; toe-brachial pressure; trauma; vascular lab studies