title: Traumatic limb amputations at a level I trauma center.
abstract: BACKGROUND
  The purpose of this study was to analyze the epidemiology and outcomes after traumatic amputation of the upper (UEA) and lower (LEA) extremities.
  
  
  METHODS
  The Los Angeles County + University of Southern California Medical Center trauma registry was utilized to identify all patients sustaining traumatic amputation during the years 1996-2007. The demographics, mechanism of injury, clinical characteristics, associated injuries, surgical procedures, complications, and outcomes were obtained for these patients.
  
  
  RESULTS
  During the 12-year study period, 130 patients suffered limb amputation, accounting for 0.25% of all trauma admissions. Thirteen patients (10%) were excluded because they were transferred from another facility after amputation or died in the emergency department. Of the remaining 117 patients, mean age was 38.1 ± 16.4 years and 77.8% were male. The predominant mechanism of injury was automobile versus pedestrian (27.4%), followed by work-related accidents (23.9%). Patients struck by vehicles were more likely to suffer LEA (93.8% versus 6.2%, p < 0.001), while patients with work-related accidents were more likely to sustain UEA (81.5% versus 18.5%, p < 0.001). Only nine patients underwent reattachment, all of which were for UEA and unsuccessful. Overall, 24.8% developed a complication during their hospital course, 55.2% of which were extremity related. Overall mortality was 3.4%, primarily attributed to associated severe traumatic brain injuries and thoracic injuries. Patients with LEA had longer hospital and intensive care unit (ICU) length of stay; however, after adjusting for confounders, this difference did not reach statistical significance (adjusted mean difference: 2.1 and 1.2 days, p = 0.69 and 0.79, respectively). A higher percentage of patients with LEA required discharge to a skilled nursing facility or rehabilitation center when compared with patients with UEA (29.6% versus 4.8%, p = 0.001).
  
  
  CONCLUSIONS
  Traumatic limb amputation is a rare consequence of civilian trauma. Amputation is rarely the primary cause of death; however, these devastating injuries are associated with significant intensive care unit and hospital lengths of stay. Although no mortality difference was detected, when compared with patients with upper extremity amputations, patients with lower extremity amputations were more severely injured, required revision extremity surgery more often, had a higher complication rate, and more frequently required discharge to a long-term facility.
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, USC + LAC Medical Center, University of Southern California, 1200 North State Street, Inpatient Tower (C), Room C5L100, Los Angeles, CA, 90033, USA.
authors.forename: L
authors.initials: L
authors.lastname: Kobayashi
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, USC + LAC Medical Center, University of Southern California, 1200 North State Street, Inpatient Tower (C), Room C5L100, Los Angeles, CA, 90033, USA. kinaba@surgery.usc.edu.
authors.forename: K
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, USC + LAC Medical Center, University of Southern California, 1200 North State Street, Inpatient Tower (C), Room C5L100, Los Angeles, CA, 90033, USA.
authors.forename: G
authors.initials: G
authors.lastname: Barmparas
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, USC + LAC Medical Center, University of Southern California, 1200 North State Street, Inpatient Tower (C), Room C5L100, Los Angeles, CA, 90033, USA.
authors.forename: M
authors.initials: M
authors.lastname: Criscuoli
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, USC + LAC Medical Center, University of Southern California, 1200 North State Street, Inpatient Tower (C), Room C5L100, Los Angeles, CA, 90033, USA.
authors.forename: T
authors.initials: T
authors.lastname: Lustenberger
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, USC + LAC Medical Center, University of Southern California, 1200 North State Street, Inpatient Tower (C), Room C5L100, Los Angeles, CA, 90033, USA.
authors.forename: P
authors.initials: P
authors.lastname: Talving
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, USC + LAC Medical Center, University of Southern California, 1200 North State Street, Inpatient Tower (C), Room C5L100, Los Angeles, CA, 90033, USA.
authors.forename: L
authors.initials: L
authors.lastname: Lam
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, USC + LAC Medical Center, University of Southern California, 1200 North State Street, Inpatient Tower (C), Room C5L100, Los Angeles, CA, 90033, USA.
authors.forename: D
authors.initials: D
authors.lastname: Demetriades
keywords: Amputations; Amputees; Complications; Epidemiology; Injury; Trauma; Traumatic amputation
references.citation: J Am Coll Surg. 2004 Sep;199(3):382-7
references.pmid: 15325607
references.citation: J Orthop Trauma. 2007 Jan;21(1):70-6
references.pmid: 17211275
references.citation: J Vasc Surg. 2006 Jul;44(1):94-100
references.pmid: 16828431
references.citation: J Bone Joint Surg Am. 2004 Aug;86-A(8):1636-45
references.pmid: 15292410
references.citation: South Med J. 2002 Aug;95(8):875-83
references.pmid: 12190225
references.citation: Am Surg. 2010 Nov;76(11):1214-22
references.pmid: 21140687
references.citation: J Am Acad Orthop Surg. 2006;14(10 Spec No.):S205-10
references.pmid: 17003200
references.citation: Injury. 1983 Nov;15(3):163-6
references.pmid: 6139337
references.citation: J Bone Joint Surg Am. 2005 Aug;87(8):1801-9
references.pmid: 16085622
references.citation: Am J Orthop (Belle Mead NJ). 2001 May;30(5):380-5
references.pmid: 11370944
references.citation: J Bone Joint Surg Am. 2007 Aug;89(8):1685-92
references.pmid: 17671005
references.citation: Am J Emerg Med. 2005 Mar;23 (2):99-105
references.pmid: 15765323
references.citation: J Orthop Trauma. 2005 Sep;19(8):529-34
references.pmid: 16118560
references.citation: Arch Phys Med Rehabil. 2008 Mar;89(3):422-9
references.pmid: 18295618