User login
PHILADELPHIA – About 7 in 10 patients who enter the trauma bay with vascular injuries are male, and about one-third have an Injury Severity Score of 15 or higher. Penetrating injuries account for more than a third of these cases, and prehospital tourniquet for extremity injuries is used in one in five patients.
These are some of the data from the first year of a registry that is gathering previously uncollected information on management of trauma-related vascular injuries, such as rates of arterial injuries, nonoperative management and amputations. Study coordinator Dr. Joseph DuBose of the University of Texas Health Science Center, Houston, reported on the PROOVIT registry – for Prospective Observational Vascular Injury Treatment – at the annual meeting of the American Association for the Surgery of Trauma (AAST).
PROOVIT grew out of an effort of the AAST leaders, Dr. DuBose said. “We discussed this with the senior leadership of the AAST as well as the AAST Multicenter Committee, recognizing there really is no registry presently that absolutely links the key variables specific to the management of vascular injury and subsequent outcome,” Dr. DuBose said.
While a number of registries exist, including the National Trauma Databank of the American College of Surgeons and the Society for Vascular Surgery Vascular Quality Initiative, along with a number of military registries, they lack key details or are not readily applicable to vascular injury in trauma, he said.
“We desire to establish an aggregate database of information on presentation, diagnosis, management, but to be acutely definitive on surveillance and outcomes in vascular trauma,” Dr. DuBose said.
First-year registry data also looked at secondary outcomes to help establish links between treatments and outcomes specific to vascular trauma, he said. PROOVIT collected data on 542 injuries from 14 trauma centers, 13 of them Level 1 centers, since February 2013. The study population included 484 arterial injuries and 79 major venous injuries (a cohort of patients had both). The most common injury cause was motor vehicle crash, accounting for 28% of all injuries, and the most common types of injuries were blunt trauma (47%) and penetrating trauma (36.5%).
PROOVIT also did a deep dive on the condition of trauma victims. Average Injury Severity Score was 20.7, and was greater than 15 in about a third of patients. A total of 121% of patients were hypotensive with systolic BP of 90 mm Hg or less, and nearly 30% of patients had some sort of vascular injury. The most common method for identifying vascular trauma injuries was CT angiography, used in nearly 40% of cases. “This database provides us an opportunity to look very closely at specific types of injury patterns,” Dr. DuBose said.
“We believe the PROOVIT registry is a viable tool based upon our first year of experience for establishing a much needed link between vascular injury management and subsequent outcome and evolving vascular injury care,” he said. The goal is to develop data out to 7 years of follow-up and beyond. “It would be my hope that we could plan that for 10- to 20-year data to collect much-needed information on long-term outcomes,” he said.
Dr. DuBose acknowledged that securing funding and enrolling more Level 2 trauma centers are goals, and that the registry is integral to quality improvement initiatives. “We can look at individual centers that have better outcomes,” he said. “What practice are they doing better than other people?”
Dr. DuBose said the registry continues to accrue patient data and the PROOVIT investigators invite all trauma centers caring for these patient populations to participate in enrollment. Information is available at the AAST multicenter studies webpage (www.aast.org/Research/MultiInstitutionalStudies.aspx), or by contacting the PROOVIT team at aastproovit@yahoo.com.
Dr. DuBose reported having no relevant financial disclosures.
This is a splendid initiative and enterprise. One might quibble with this early delivery of results to this audience. It is perhaps a bit premature, but it is clearly post-natal, and the results should engender comments that might increase its influence.
The PROOVIT finding that tourniquets were used in 20% of vascular injuries is heartwarming. This would not have occurred 2 decades ago, and it’s a testament to the influence of tactical combat casualty care, However, cost is a determinant for the future of the registry. The cost must be estimated and it must be borne by some body of support.
Dr. Howard Champion is a trauma surgeon in Annapolis, Md. He was the discussant of the presentation at the meeting.
This is a splendid initiative and enterprise. One might quibble with this early delivery of results to this audience. It is perhaps a bit premature, but it is clearly post-natal, and the results should engender comments that might increase its influence.
The PROOVIT finding that tourniquets were used in 20% of vascular injuries is heartwarming. This would not have occurred 2 decades ago, and it’s a testament to the influence of tactical combat casualty care, However, cost is a determinant for the future of the registry. The cost must be estimated and it must be borne by some body of support.
Dr. Howard Champion is a trauma surgeon in Annapolis, Md. He was the discussant of the presentation at the meeting.
This is a splendid initiative and enterprise. One might quibble with this early delivery of results to this audience. It is perhaps a bit premature, but it is clearly post-natal, and the results should engender comments that might increase its influence.
The PROOVIT finding that tourniquets were used in 20% of vascular injuries is heartwarming. This would not have occurred 2 decades ago, and it’s a testament to the influence of tactical combat casualty care, However, cost is a determinant for the future of the registry. The cost must be estimated and it must be borne by some body of support.
Dr. Howard Champion is a trauma surgeon in Annapolis, Md. He was the discussant of the presentation at the meeting.
PHILADELPHIA – About 7 in 10 patients who enter the trauma bay with vascular injuries are male, and about one-third have an Injury Severity Score of 15 or higher. Penetrating injuries account for more than a third of these cases, and prehospital tourniquet for extremity injuries is used in one in five patients.
These are some of the data from the first year of a registry that is gathering previously uncollected information on management of trauma-related vascular injuries, such as rates of arterial injuries, nonoperative management and amputations. Study coordinator Dr. Joseph DuBose of the University of Texas Health Science Center, Houston, reported on the PROOVIT registry – for Prospective Observational Vascular Injury Treatment – at the annual meeting of the American Association for the Surgery of Trauma (AAST).
PROOVIT grew out of an effort of the AAST leaders, Dr. DuBose said. “We discussed this with the senior leadership of the AAST as well as the AAST Multicenter Committee, recognizing there really is no registry presently that absolutely links the key variables specific to the management of vascular injury and subsequent outcome,” Dr. DuBose said.
While a number of registries exist, including the National Trauma Databank of the American College of Surgeons and the Society for Vascular Surgery Vascular Quality Initiative, along with a number of military registries, they lack key details or are not readily applicable to vascular injury in trauma, he said.
“We desire to establish an aggregate database of information on presentation, diagnosis, management, but to be acutely definitive on surveillance and outcomes in vascular trauma,” Dr. DuBose said.
First-year registry data also looked at secondary outcomes to help establish links between treatments and outcomes specific to vascular trauma, he said. PROOVIT collected data on 542 injuries from 14 trauma centers, 13 of them Level 1 centers, since February 2013. The study population included 484 arterial injuries and 79 major venous injuries (a cohort of patients had both). The most common injury cause was motor vehicle crash, accounting for 28% of all injuries, and the most common types of injuries were blunt trauma (47%) and penetrating trauma (36.5%).
PROOVIT also did a deep dive on the condition of trauma victims. Average Injury Severity Score was 20.7, and was greater than 15 in about a third of patients. A total of 121% of patients were hypotensive with systolic BP of 90 mm Hg or less, and nearly 30% of patients had some sort of vascular injury. The most common method for identifying vascular trauma injuries was CT angiography, used in nearly 40% of cases. “This database provides us an opportunity to look very closely at specific types of injury patterns,” Dr. DuBose said.
“We believe the PROOVIT registry is a viable tool based upon our first year of experience for establishing a much needed link between vascular injury management and subsequent outcome and evolving vascular injury care,” he said. The goal is to develop data out to 7 years of follow-up and beyond. “It would be my hope that we could plan that for 10- to 20-year data to collect much-needed information on long-term outcomes,” he said.
Dr. DuBose acknowledged that securing funding and enrolling more Level 2 trauma centers are goals, and that the registry is integral to quality improvement initiatives. “We can look at individual centers that have better outcomes,” he said. “What practice are they doing better than other people?”
Dr. DuBose said the registry continues to accrue patient data and the PROOVIT investigators invite all trauma centers caring for these patient populations to participate in enrollment. Information is available at the AAST multicenter studies webpage (www.aast.org/Research/MultiInstitutionalStudies.aspx), or by contacting the PROOVIT team at aastproovit@yahoo.com.
Dr. DuBose reported having no relevant financial disclosures.
PHILADELPHIA – About 7 in 10 patients who enter the trauma bay with vascular injuries are male, and about one-third have an Injury Severity Score of 15 or higher. Penetrating injuries account for more than a third of these cases, and prehospital tourniquet for extremity injuries is used in one in five patients.
These are some of the data from the first year of a registry that is gathering previously uncollected information on management of trauma-related vascular injuries, such as rates of arterial injuries, nonoperative management and amputations. Study coordinator Dr. Joseph DuBose of the University of Texas Health Science Center, Houston, reported on the PROOVIT registry – for Prospective Observational Vascular Injury Treatment – at the annual meeting of the American Association for the Surgery of Trauma (AAST).
PROOVIT grew out of an effort of the AAST leaders, Dr. DuBose said. “We discussed this with the senior leadership of the AAST as well as the AAST Multicenter Committee, recognizing there really is no registry presently that absolutely links the key variables specific to the management of vascular injury and subsequent outcome,” Dr. DuBose said.
While a number of registries exist, including the National Trauma Databank of the American College of Surgeons and the Society for Vascular Surgery Vascular Quality Initiative, along with a number of military registries, they lack key details or are not readily applicable to vascular injury in trauma, he said.
“We desire to establish an aggregate database of information on presentation, diagnosis, management, but to be acutely definitive on surveillance and outcomes in vascular trauma,” Dr. DuBose said.
First-year registry data also looked at secondary outcomes to help establish links between treatments and outcomes specific to vascular trauma, he said. PROOVIT collected data on 542 injuries from 14 trauma centers, 13 of them Level 1 centers, since February 2013. The study population included 484 arterial injuries and 79 major venous injuries (a cohort of patients had both). The most common injury cause was motor vehicle crash, accounting for 28% of all injuries, and the most common types of injuries were blunt trauma (47%) and penetrating trauma (36.5%).
PROOVIT also did a deep dive on the condition of trauma victims. Average Injury Severity Score was 20.7, and was greater than 15 in about a third of patients. A total of 121% of patients were hypotensive with systolic BP of 90 mm Hg or less, and nearly 30% of patients had some sort of vascular injury. The most common method for identifying vascular trauma injuries was CT angiography, used in nearly 40% of cases. “This database provides us an opportunity to look very closely at specific types of injury patterns,” Dr. DuBose said.
“We believe the PROOVIT registry is a viable tool based upon our first year of experience for establishing a much needed link between vascular injury management and subsequent outcome and evolving vascular injury care,” he said. The goal is to develop data out to 7 years of follow-up and beyond. “It would be my hope that we could plan that for 10- to 20-year data to collect much-needed information on long-term outcomes,” he said.
Dr. DuBose acknowledged that securing funding and enrolling more Level 2 trauma centers are goals, and that the registry is integral to quality improvement initiatives. “We can look at individual centers that have better outcomes,” he said. “What practice are they doing better than other people?”
Dr. DuBose said the registry continues to accrue patient data and the PROOVIT investigators invite all trauma centers caring for these patient populations to participate in enrollment. Information is available at the AAST multicenter studies webpage (www.aast.org/Research/MultiInstitutionalStudies.aspx), or by contacting the PROOVIT team at aastproovit@yahoo.com.
Dr. DuBose reported having no relevant financial disclosures.
AT THE AAST ANNUAL MEETING
Key clinical point: Gathering previously uncollected information on management of trauma-related vascular injuries can inform treatment and may improve outcomes.
Major finding: The most common injury cause was motor vehicle crash, accounting for 28% of all injuries, and the most common types of injuries were blunt trauma (47%) and penetrating trauma (36.5%).
Data source: The AAST PROOVIT registry involving 13 Level 1 and 1 Level 2 trauma centers with data on 542 injuries.
Disclosures: Dr. DuBose reported having no relevant financial disclosures.