title: Vascular injury is associated with increased mortality in winter sports trauma.
abstract: BACKGROUND
  Trauma is the leading cause of injury and death for individuals aged 1-44 years. Up to 8% of the US population participates in winter sports, and although vascular injuries are uncommon in these activities, little is published in this area. We sought to identify the incidence, injury patterns, and outcomes of vascular injuries resulting from winter sports trauma.
  
  
  METHODS
  Patients with winter sports trauma and the subset with vascular injuries were identified by accessing the National Trauma Data Bank querying years 2007-2010. Patients with and without vascular injuries were then compared. Admission variables included transport time, emergency department hypotension (systolic blood pressure < 90), Glasgow Coma Scale ≤ 8, Injury Severity Score ≥ 25, fractures, solid organ injury, and vascular injury. Outcomes were analyzed and associations with vascular injuries were determined.
  
  
  RESULTS
  A total of 2,298 patients were identified with winter sports-related trauma and 28 (1.2%) had associated vascular injuries. Overall, the top 3 injuries were head trauma (16.7%), thoracic vertebral fractures (5.5%), and lumbar vertebral fractures (5.1%). The most common associated vascular injures were to the popliteal artery (17.7%), splenic artery (14.7%), and brachial blood vessels (14.7%). In the entire cohort, 1 patient (0.04%) suffered an amputation and 15 patients (0.7%) died. There were no amputations in the vascular injury group. Mortality was 0.6% in patients without a vascular injury compared with 7.1% of those with a vascular injury (P = 0.01).
  
  
  CONCLUSIONS
  Although vascular injury is an uncommon associated finding in winter sports trauma, it is associated with a significant increase in mortality. These findings highlight the need for rapid identification of traumatic vascular injuries, which predicts worse overall outcomes in this patient population.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Colorado Denver, Aurora, CO.
authors.forename: John C
authors.initials: JC
authors.lastname: Eun
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Colorado Denver, Aurora, CO.
authors.forename: Michael
authors.initials: M
authors.lastname: Bronsert
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Colorado Denver, Aurora, CO.
authors.forename: Kristine
authors.initials: K
authors.lastname: Hansen
authors.affiliation: Department of Surgery, Primary Children's Hospital, Salt Lake City, UT; Department of Surgery, Children's Hospital Colorado, Aurora, CO.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moulton
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Colorado Denver, Aurora, CO.
authors.forename: Omid
authors.initials: O
authors.lastname: Jazaeri
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Colorado Denver, Aurora, CO. Electronic address: Mark.Nehler@ucdenver.edu.
authors.forename: Mark
authors.initials: M
authors.lastname: Nehler
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Colorado Denver, Aurora, CO.
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Greenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012621:Seasons; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D055815:Young Adult