![]() ![]() Further prospective study is needed to validate this proposed redefinition of categorization of presentations of extremity arterial injury.Ĭopyright © 2020 American Association for the Surgery of Trauma. A strategy of using hemorrhagic and ischemic signs of vascular injury is of greater clinical utility. Hard signs have limitations in identification and characterization of extremity arterial injuries. There was no difference in amputation rate, reintervention rate, hospital length of stay, or mortality in comparing groups who underwent CTA versus exploration. Patients with ischemic signs undergoing exploration for diagnosis received more units of packed red blood cells during the first 24 hours. Hemorrhagic signs were associated with arterial transection, while ischemic signs were associated with arterial occlusion. It mostly occurs with motor vehicle collisions. Vascular injury occurs in 13 of all BNT and is associated with 2030 mortality. There are various sources of blunt neck trauma and each is associated with a specific pattern of injury. Of the 490 patients presenting with ischemic signs, CTA was performed 31.6% of the time and was associated with higher rates of EHR and observation. Table 1 presents hard/soft signs for arterial injuries. Of 915 patients presenting with hemorrhagic signs, CTA was performed 14.5% of the time and was associated with a higher rate of EHR and observation. ![]() Patients undergoing CTA were more likely to undergo endovascular or hybrid repair (EHR) (10.7%) compared with patients who underwent exploration for diagnosis (1.5%). The role of high-flow nasal oxygen (HFNO) to assist airway management in blunt and penetrating neck trauma is unclear. Computed tomography angiography (CTA) was more commonly used as the diagnostic modality in patients without hard signs, while operative exploration was primarily used for diagnosis in hard signs. Of 1,910 cases, 1,108 (58%) had hard signs of vascular injury. If the patient does not have hard signs of injury, but clinical suspicion remains high, imaging can be obtained. We propose that hard signs are outdated and that hemorrhagic and ischemic signs of vascular injury may be of greater clinical utility.Įxtremity arterial injuries from the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment registry were analyzed to examine the relationships between hard signs, ischemic signs, and hemorrhagic signs of extremity vascular injury with workup, diagnosis, and management. Obvious neck trauma with hard signs of vascular compromise on the initial or secondary survey will require operative exploration. ![]() Despite advances in management of extremity vascular injuries, "hard signs" remain the primary criterion to determine need for imaging and urgency of exploration. ![]()
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