The pelvic vascular injury score (P-VIS): a prehospital instrument to detect significant vascular injury in pelvic fractures
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| Titel: | The pelvic vascular injury score (P-VIS): a prehospital instrument to detect significant vascular injury in pelvic fractures |
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| Autoren: | Spering, Christopher, Lehmann, Wolfgang, Möller, Stefanie, Bieler, Dan, Schweigkofler, Uwe, Hackenberg, Lisa, Sehmisch, Stephan, Lefering, Rolf, TraumaRegister DGU |
| Weitere Verfasser: | Spering, Christopher, Lehmann, Wolfgang, Möller, Stefanie, Bieler, Dan, Schweigkofler, Uwe, Hackenberg, Lisa, Sehmisch, Stephan, Lefering, Rolf, TraumaRegister DGU |
| Quelle: | Eur J Trauma Emerg Surg |
| Verlagsinformationen: | Springer Science and Business Media LLC, 2023. |
| Publikationsjahr: | 2023 |
| Schlagwörter: | Male, Adult, Emergency Medical Services, Hemorrhage, Vascular System Injuries, Middle Aged, 3. Good health, Fractures, Bone, Injury Severity Score, Trauma Centers, Humans, Original Article, Female, Female [MeSH], Trauma Centers [MeSH], Aged [MeSH], Injury Severity Score [MeSH], Prehospital score, Adult [MeSH], Humans [MeSH], Retrospective Studies [MeSH], Middle Aged [MeSH], Peripelvic vascular injury, Vascular System Injuries/complications [MeSH], Fractures, Bone/complications [MeSH], Pelvic injury, Control bleeding, Male [MeSH], Hemorrhage/etiology [MeSH], Pelvic Bones/injuries [MeSH], Pelvic bleeding, Emergency Medical Services/methods [MeSH], Pelvic Bones, Aged, Retrospective Studies |
| Beschreibung: | Purpose The purpose of this study was to identify predictive factors for peri-pelvic vascular injury in patients with pelvic fractures and to incorporate these factors into a pelvic vascular injury score (P-VIS) to detect severe bleeding during the prehospital trauma management. Methods To identify potential predictive factors, data were taken (1) of a Level I Trauma Centre with 467 patients (ISS ≥ 16 and AISPelvis ≥ 3). Analysis including patient’s charts and digital recordings, radiographical diagnostics, mechanism and pattern of injury as well as the vascular bleeding source was performed. Statistical analysis was performed descriptively and through inference statistical calculation. To further analyse the predictive factors and finally develop the score, a 10-year time period (2012–2021) of (2) the TraumaRegister DGU® (TR-DGU) was used in a second step. Relevant peri-pelvic bleeding in patients with AISPelvis ≥ 3 (N = 9227) was defined as a combination of the following entities (target group PVITR-DGUN = 2090; 22.7%): pelvic fracture with significant bleeding (> 20% of blood volume), Injury of the iliac or femoral artery or blood transfusion of ≥ 6 units (pRBC) prior to ICU admission. The multivariate analysis revealed nine items that constitute the pelvic vascular injury score (P-VIS). Results In study (1), 467 blunt pelvic trauma patients were included of which 24 (PVI) were presented with significant vascular injury (PVI, N = 24; control (C, N = 443). Patients with pelvic fractures and vascular injury showed a higher ISS, lower haemoglobin at admission and lower blood pressure. Their mortality rate was higher (PVI: 17.4%, C: 10.3%). In the defining and validating process of the score within the TR-DGU, 9227 patients met the inclusion criteria. 2090 patients showed significant peripelvic vascular injury (PVITR-DGU), the remaining 7137 formed the control group (CTR-DGU). Nine predictive parameters for peripelvic vascular injury constituted the peripelvic vascular injury score (P-VIS): age ≥ 70 years, high-energy-trauma, penetrating trauma/open pelvic injury, shock index ≥ 1, cardio-pulmonary-resuscitation (CPR), substitution of > 1 l fluid, intubation, necessity of catecholamine substitution, remaining shock (≤ 90 mmHg) under therapy. The multi-dimensional scoring system leads to an ordinal scaled rating according to the probability of the presence of a vascular injury. A score of ≥ 3 points described the peripelvic vascular injury as probable, a result of ≥ 6 points identified a most likely vascular injury and a score of 9 points identified an apparent peripelvic vascular injury. Reapplying this score to the study population a median score of 5 points (range 3–8) (PVI) and a median score of 2 points (range 0–3) (C) (p 3 points vs. ≤ 2 points. The TR-DGU data set verified these findings (median of 2 points in CTR-DGU vs. median of 3 points with in PVITR-DGU). Conclusion The pelvic vascular injury score (P-VIS) allows an initial risk assessment for the presence of a vascular injury in patients with unstable pelvic injury. Thus, the management of these patients can be positively influenced at a very early stage, prehospital resuscitation performed safely targeted and further resources can be activated in the final treating Trauma Centre. |
| Publikationsart: | Article Other literature type |
| Sprache: | English |
| ISSN: | 1863-9941 1863-9933 |
| DOI: | 10.1007/s00068-023-02374-x |
| Zugangs-URL: | https://pubmed.ncbi.nlm.nih.gov/37872264 https://resolver.sub.uni-goettingen.de/purl?gro-2/138735 https://repository.publisso.de/resource/frl:6523262 |
| Rights: | CC BY |
| Dokumentencode: | edsair.doi.dedup.....0f47ddc123c7af6cf016be88b3d78c8e |
| Datenbank: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstract: | Purpose The purpose of this study was to identify predictive factors for peri-pelvic vascular injury in patients with pelvic fractures and to incorporate these factors into a pelvic vascular injury score (P-VIS) to detect severe bleeding during the prehospital trauma management. Methods To identify potential predictive factors, data were taken (1) of a Level I Trauma Centre with 467 patients (ISS ≥ 16 and AISPelvis ≥ 3). Analysis including patient’s charts and digital recordings, radiographical diagnostics, mechanism and pattern of injury as well as the vascular bleeding source was performed. Statistical analysis was performed descriptively and through inference statistical calculation. To further analyse the predictive factors and finally develop the score, a 10-year time period (2012–2021) of (2) the TraumaRegister DGU® (TR-DGU) was used in a second step. Relevant peri-pelvic bleeding in patients with AISPelvis ≥ 3 (N = 9227) was defined as a combination of the following entities (target group PVITR-DGUN = 2090; 22.7%): pelvic fracture with significant bleeding (> 20% of blood volume), Injury of the iliac or femoral artery or blood transfusion of ≥ 6 units (pRBC) prior to ICU admission. The multivariate analysis revealed nine items that constitute the pelvic vascular injury score (P-VIS). Results In study (1), 467 blunt pelvic trauma patients were included of which 24 (PVI) were presented with significant vascular injury (PVI, N = 24; control (C, N = 443). Patients with pelvic fractures and vascular injury showed a higher ISS, lower haemoglobin at admission and lower blood pressure. Their mortality rate was higher (PVI: 17.4%, C: 10.3%). In the defining and validating process of the score within the TR-DGU, 9227 patients met the inclusion criteria. 2090 patients showed significant peripelvic vascular injury (PVITR-DGU), the remaining 7137 formed the control group (CTR-DGU). Nine predictive parameters for peripelvic vascular injury constituted the peripelvic vascular injury score (P-VIS): age ≥ 70 years, high-energy-trauma, penetrating trauma/open pelvic injury, shock index ≥ 1, cardio-pulmonary-resuscitation (CPR), substitution of > 1 l fluid, intubation, necessity of catecholamine substitution, remaining shock (≤ 90 mmHg) under therapy. The multi-dimensional scoring system leads to an ordinal scaled rating according to the probability of the presence of a vascular injury. A score of ≥ 3 points described the peripelvic vascular injury as probable, a result of ≥ 6 points identified a most likely vascular injury and a score of 9 points identified an apparent peripelvic vascular injury. Reapplying this score to the study population a median score of 5 points (range 3–8) (PVI) and a median score of 2 points (range 0–3) (C) (p 3 points vs. ≤ 2 points. The TR-DGU data set verified these findings (median of 2 points in CTR-DGU vs. median of 3 points with in PVITR-DGU). Conclusion The pelvic vascular injury score (P-VIS) allows an initial risk assessment for the presence of a vascular injury in patients with unstable pelvic injury. Thus, the management of these patients can be positively influenced at a very early stage, prehospital resuscitation performed safely targeted and further resources can be activated in the final treating Trauma Centre. |
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| ISSN: | 18639941 18639933 |
| DOI: | 10.1007/s00068-023-02374-x |