Physical diagnostics of arterial trauma in patients of various ages
DOI:
https://doi.org/10.14739/2310-1210.2020.4.208368Keywords:
arterial injuries, symptom vessel injuries, children, adultsAbstract
Aim. To evaluate the effectiveness of physical methods for diagnosing arterial trauma (AT) in patients of various ages.
Materials and methods. The hospital medical records data of 222 patients with AT of various ages who were on treatment in the Vascular Surgery Department of Lviv Regional Clinical Hospital in 1992–2019 were analyzed. The patients were divided into seven groups: infants (≤2 years, 4.05 %), early childhood (3–6 years, 0.9 %), childhood (7–12 years, 4.05 %), adolescents (13–18 years, 11.3 %), young adults (19–40 years, 48.6 %), adults (41–65 years, 24.8 %), elderly (≥66 years, 6.3 %). AT was determined from the hard (pulsatile bleeding, absent pulsations distal to the trauma site, expanding hematoma, thrill or bruit over the trauma site, signs of ischemia) or soft (bleeding history, weakened pulsation on an injured side, nonpulsatile hematoma, bone fracture or wound in the projection of a vessel, neurological disorders) symptoms. Physical examination results were compared with intraoperative findings (n = 202, 91 %) or comprehensive instrumental examination.
Results. Patients of all ages with AT had a combination of hard and soft symptoms in 44.6–68.8 % (95 % CI) of cases, 10.3–45.0 % (95 % CI) had soft symptoms, and 5.4–23.5 % (95 % CI) had hard symptoms of AT. According to the multiple regression model, the type of AT symptoms was influenced by the mechanism of injury, rather patient's age, etiology, topography, or type of pathomorphological changes in the vessels. Physical examination methods were sufficient to establish a clinical diagnosis of AT and to choose a treatment modality in 20.0–48.3 % (95 % CI) of patients of all ages. The method for diagnosing AT (physical or combination of physical with instrumental) was influenced by patient's age, year of hospitalization and mechanism of injury.
Conclusions. Physical methods for diagnosing AT (hard and soft symptoms) have high diagnostic value in examining patients of all ages.
References
Rasmussen, T. E., Tai, N. R. M., & Rich, N. M. (Eds.). (2016). Rich’s vascular trauma. (3rd ed.). Elsevier.
Evans, C., Chaplin, T., & Zelt, D. (2018). Management of Major Vascular Injuries. Emergency Medicine Clinics of North America, 36(1), 181-202. https://doi.org/10.1016/j.emc.2017.08.013
Nahalyuk, Yu. V., Koval, B. M., Litvinova, N. Yu., Rogovskyj, V. М., Tsema, Ye. V., & Mishalov, V. G. (2015). Pytannia diahnostyky vohnepalnykh poshkodzhen mahistralnykh sudyn [The diagnosis of gunshot injuries of major vessels]. Sertse i sudyny, (1), 101-109. [in Ukrainian].
Chen, W., Su, Y., Zhang, Q., Zhang, Y., Smith, W. R., Ma, L., Guo, M., Zheng, Z., Qin, D., & Liu, J. (2012). A proposed new system of coding and injury classification for arteries in the trunk and extremities. Injury, 43(9), 1539-1546. https://doi.org/10.1016/j.injury.2010.09.005
Quinn, V. N. (1997). Applying Psychology. (3rd ed.). McGraw-Hill Humanities.
Milyukov, V. E., & Zharikova, T. S. (2015). Kriterii formirovaniya vozrastnykh grupp patsientov v meditsinskikh issledovaniyakh [Criteria for the formation of patients’ age groups for medical research]. Klinicheskaya meditsina, 93(11), 5-11. [in Russian].
Feliciano, D. V., Moore, F. A., Moore, E. E., West, M. A., Davis, J. W., Cocanour, C. S., Kozar, R. A., & McIntyre, R. C. (2011). Evaluation and Management of Peripheral Vascular Injury. Part 1. Western Trauma Association/Critical Decisions in Trauma. The Journal of Trauma: Injury, Infection, and Critical Care, 70(6), 1551-1556. https://doi.org/10.1097/ta.0b013e31821b5bdd
Gümbel, D., Naundorf, M., Napp, M., Ekkernkamp, A., & Seifert, J. (2014). Diagnostik und Management peripherer Gefäßverletzungen. Der Unfallchirurg, 117(5), 445-460. https://doi.org/10.1007/s00113-014-2560-0
Modrall, J. G., Weaver, F. A., & Yellin, A. E. (1995). Diagnosis of vascular trauma. Annals of vascular surgery, 9(4), 415-421. https://doi.org/10.1007/BF02139416
deSouza, I. S., Benabbas, R., McKee, S., Zangbar, B., Jain, A., Paladino, L., Boudourakis, L., & Sinert, R. (2017). Accuracy of Physical Examination, Ankle-Brachial Index, and Ultrasonography in the Diagnosis of Arterial Injury in Patients With Penetrating Extremity Trauma: A Systematic Review and Meta-analysis. Academic Emergency Medicine, 24(8), 994-1017. https://doi.org/10.1111/acem.13227
Protack, C., Wengerter, B., Jean, R., Liu, S., Mojibian, H., Sumpio, B., Dardik, A., Maung, A., & Erben, Y. (2017). Overutilization of Cross-Sectional Imaging in the Lower Extremity Trauma Setting. International Journal of Angiology, 27(1), 23-28. https://doi.org/10.1055/s-0037-1612622
Inaba, K., Branco, B. C., Reddy, S., Park, J. J., Green, D., Plurad, D., Talving, P., Lam, L., & Demetriades, D. (2011). Prospective Evaluation of Multidetector Computed Tomography for Extremity Vascular Trauma. The Journal of Trauma: Injury, Infection, and Critical Care, 70(4), 808-815. https://doi.org/10.1097/ta.0b013e3182118384
Bonasso, P. C., Dassinger, M. S., Smeds, M. R., & Moursi, M. M. (2019). Pediatric Vascular Surgical Practice Patterns. Annals of Vascular Surgery, 54, 103-109.e8. https://doi.org/10.1016/j.avsg.2018.05.033
Ammar, A. A. (2016). Peripheral Arterial Injuries in Pediatric Age Group. Journal of Trauma and Injury, 29(2), 37-42. https://doi.org/10.20408/jti.2016.29.2.37
Sciarretta, J. D., Macedo, F. I. B., Chung, E. L., Otero, C. A., Pizano, L. R., & Namias, N. (2014). Management of lower extremity vascular injuries in pediatric trauma patients. Journal of Trauma and Acute Care Surgery, 76(6), 1386-1389. https://doi.org/10.1097/ta.0000000000000225
Baram, A., Kakamad, F. H., Shali, W. F., & Sayed-Nouri, R. (2015). Vascular Trauma Registry Analysis in Sulaimani Province of Southern Kurdistan. Surgical Science, 6(8), 369-375. https://doi.org/10.4236/ss.2015.68054
Jaha, L., Andreevska, T., Rudari, H., Ademi, B., & Ismaili-Jaha, V. (2012). A decade of civilian vascular trauma in Kosovo. World Journal of Emergency Surgery, 7(1), Article 24. https://doi.org/10.1186/1749-7922-7-24
Mattox, K. L., Feliciano, D. V., Burch, J., Beall, A. C., Jr, Jordan, G. L., Jr, & De Bakey, M. E. (1989). Five thousand seven hundred sixty cardiovascular injuries in 4459 patients. Epidemiologic evolution 1958 to 1987. Annals of surgery, 209(6), 698-707. https://doi.org/10.1097/00000658-198906000-00007
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)