Existing Trauma and Critical Care Scoring Systems Underestimate Mortality among Vascular Trauma Patients

OBJECTIVES:
The impact of vascular injuries on patient mortality has not been well documented in multi-trauma patients. This study seeks to determine 1) whether the presence of vascular injury negatively affects patient outcome compared to non-vascular trauma (NVT) patients and 2) the utility of existing severity scoring systems in predicting mortality among vascular trauma (VT) patients.
METHODS:
A retrospective review of the trauma database from January 2005 to December 2007 was conducted. Demographics, Injury Severity Scores (ISS), Revised Trauma Scores (RTS), APACHE II scores, and mortality were compared. Control patients were selected from a matching cohort based on ISS. Comparisons were made between VT and NVT patients grouped into categories of severity based on the above scoring systems. These systems have been shown in the literature to be predictive of mortality. Statistical analysis was performed using Chi-squared analysis and Students’ t-tests.
RESULTS:
Fifty VT and fifty NVT patients were identified with no significant differences in age, gender, mechanism of injury, ISS, or RTS scores. The mean APACHE II score was higher in VT patients compared to NVT patients (12.3 vs. 8.8, p<0.05). Overall mortality was higher in VT patients compared to NVT patients but did not reach statistical significance (24% vs. 11.8%, p=0.108). VT patients with an RTS score > 5 had a higher mortality rate (26% vs. 2.2%, p=0.007). VT also predicted higher mortality in patients with an ISS score > 24 (61% vs. 28.6%, p=0.04). Finally, VT patients with an APACHE II score < 14 also had a higher mortality rate (18.2 % vs. 0%, p=0.007).
CONCLUSIONS:
In multi-trauma patients, the presence of a vascular injury was associated with increased mortality as compared to non-vascular trauma patients with similar ISS and RTS scores. These scoring systems underestimated the mortality of patients with vascular trauma.