Incidence and characteristics of vascular trauma at a level 2 trauma center

Despite the significant number of trauma patients treated at level 2 trauma centers (L2TC) in the United States, most of the literature describing vascular trauma is from level 1 trauma centers (L1TC). Currently, trauma center designation criteria do not require vascular surgery as a necessary component service. A retrospective chart review was performed for all trauma patients with a vascular surgery consultation (VSC) seen at our L2TC between 2013 and 2018. Patient demographics, injury characteristics, and outcomes were collected and analyzed with descriptive statistics. Of the 3,062 trauma patients evaluated at our L2TC, 110 (3.6%) had a VSC. Operative intervention was performed in 35.2% of consults, and 1.0% of all trauma patients had a vascular intervention. Average age was 57 years-old, and the majority was male (68.2%, n=75). Mean Injury Severity Score (ISS) was 12.0 +/- 9.6, and blunt injury (87.5%, n=77) was more common than penetrating (12.5%, n=11). The most common location of injury was the lower extremity (74.2%, n=23), followed by upper extremity (9.7%, n=3), chest (6.5%, n=2), neck (6.5%, n=2), and pelvis (3.2%, n=1). Endovascular interventions were performed by the vascular surgery service in 67.7% (n=21) of all injuries. There was one (3.2%) amputation and one (3.2%) post-operative mortality. At our L2TC, postoperative morbidity and mortality rates at 30 days were substantially lower compared to previously reported data. However, mean ISS and the incidence of penetrating and polytrauma were also lower at our institution. Most patients were managed nonoperatively, but when they did require an operation, endovascular therapies were more commonly implemented. Vascular surgery should be considered an integral service in trauma level designation, and there is a need for further investigation of these outcomes in L2TCs. Type of Research: Single-center retrospective cohort study Key Findings: There were 110 trauma patients with a vascular surgery consultation at our institution between 2013 and 2018. Blunt injury (87.5%, n=77) was more common than penetrating (12.5%, n=11), and operative intervention was performed in 35.2% of consults. Endovascular interventions were performed in 67.7% (n=21) of all injuries. Take-Home Message: Vascular surgery should be considered an integral service in trauma level designation, and there is a need for further investigation of these outcomes in L2TCs.