[Vascular injury-An underestimated entity?]

Background: Vessels are not frequently affected in traumatology and isolated vascular trauma (VT) is rare; therefore, there is a lack of reliable and current data on the incidence and mortality. Objective: This article reports on the status of VT in trauma care of the severely injured in Germany based on selected references and data from our own published analyses and current studies from the data of the TraumaRegister DGU® (TR-DGU). Material and methods: Selected review of the literature and report on 2 retrospective assessments of datasets of the TR-DGU. Records with moderate to severe VT in the injury pattern were compared to records of cases without VT (non-VT) with the same injury severity. Target parameters were morbidity, mortality and parameters of the clinical course and prognosis. Results: The 2002-2012 database evaluation (TR-DGU Project-ID 2013-011) revealed an impact of allocation and level of care of the trauma centers on expected mortality (EM) and observed mortality (OM) in 2961 cases with VT among 42,326 severely injured patients (7%). The difference between OM and EM in VT was + 3.4% vs. ± 0.1% in non-VT. Due to an OM in severe VT of 33.8% vs. 16.4% in non-VT with identical injury severity, the subsequent analysis of 2008-2017 (TR-DGU Project-ID 2018-045) was initiated. The sub-stratification of isolated, main and concomitant VT could show a significant effect of the treatment level, allocation and transport on the OM in the treatment reality. A relevant mismatch of OM to EM could only be shown in VT, on average ca. + 2% and in high-risk constellations with VT up to + 29% as a measure for the relevance of VT in trauma care. Conclusion: These results indicate a substantial need for further optimization of emergency care of severely injured patients with VT, where VT vigilance, allocation, transportation and a low threshold early re-allocation can be derived as starting points.