C. McDaniel1, N. Samra1, B. Hu2, W. Zhang1, T. Tan1 1Louisiana State University Health Sciences Center, Shreveport,Vascular And Endovascular Surgery,Shreveport, LA, USA 2Cleveland Clinic,Cleveland, OHIO, USA
Introduction:
Care of patients with vascular trauma often poses complex challenges that prompt transfer to higher-level trauma centers. We seek to investigate the impact of hospital transfer on the outcomes of patients with isolated lower extremity vascular injuries.
Methods:
A retrospective review of the National Trauma Data Bank (2007-2014) was performed to identify patients with isolated lower extremity vascular injury. Bivariate analysis was used to compare patient characteristics and outcomes between those transferred into level I centers and patients treated at non-level I trauma centers. Multivariable logistic regression was used to examine association between hospital transfer and outcomes, as well as factors associated with fasciotomy.
Results:
Among 2,698 with lower extremity vascular trauma included in the study, 35% (956) were transfer to level I trauma centers and 65% (1,742) were treated in non-level I centers. Overall amputation rate was 12% and fasciotomy rate was 35%, and were similar between two cohorts (Table 1). Although there were no significant impact on mortality or amputation rates, hospital transfer was associated with increased risk of fasciotomy (OR 1.3, 95% CI 1.1-1.6, p=.002) in patients with lower extremity vascular injuries. Other factors associated with fasciotomy were open surgery (OR 1.8, 95% CI 1.4-2.2,p<.001), venous (OR 1.5, 95% CI 1.1-2.0,P=.02) and nerve injury (OR 2.7, 95% CI 2.2-3.2,p<.001).
Conclusions:
Hospital transfer was associated with increased risk of fasciotomy that might be secondary to potential delay in care in patients with lower extremity vascular injuries.
