Физикальная диагностика травм артерий у больных разного возраста

V. F. Petrov

doi:10.14739/2310-1210.2020.4.208368

Authors

V. F. Petrov Danylo Halytsky Lviv National Medical University, Ukraine, https://orcid.org/0000-0002-2205-5403

DOI:

https://doi.org/10.14739/2310-1210.2020.4.208368

Keywords:

arterial injuries, symptom vessel injuries, children, adults

Abstract

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