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The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry: Multicenter data on modern vascular injury diagnosis, management, and outcomes

DuBose, Joseph J. MD; Savage, Stephanie A. MD; Fabian, Timothy C. MD; Menaker, Jay MD; Scalea, Thomas MD; Holcomb, John B. MD; Skarupa, David MD; Poulin, Nathaniael MD; Chourliaras, Konstantinos MD; Inaba, Kenji MD; Rasmussen, Todd E. MDAAST PROOVIT Study Group

Journal of Trauma and Acute Care Surgery: February 2015 - Volume 78 - Issue 2 - p 215–223
doi: 10.1097/TA.0000000000000520
AAST 2014 Plenary Papers
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BACKGROUND There is a need for a prospective registry designed to capture trauma-specific, in-hospital, and long-term outcomes related to vascular injury.

METHODS The American Association for the Surgery of Trauma PROspective Vascular Injury Treatment (PROOVIT) registry was used to collect demographic, diagnostic, treatment, and outcome data on vascular injuries.

RESULTS A total of 542 injuries from 14 centers (13 American College of Surgeons–verified Level I and 1 American College of Surgeons–verified Level II) have been captured since February 2013. The majority of patients are male (70.5%), with an Injury Severity Score (ISS) of 15 or greater among 32.1%. Penetrating mechanisms account for 36.5%. Arterial injuries to the head/neck (26.7%), thorax (10.4%), abdomen/pelvis (7.8%), upper extremity (18.4%), and lower extremity (26.0%) were identified, along with 98 major venous injuries. Hard signs of vascular injury, including hypotension (systolic blood pressure < 90 mm Hg, 11.8%), were noted in 28.6%. Prehospital tourniquet use for extremity injuries occurred in 20.2% (47 of 233). Diagnostic modalities included exploration (28.8%), computed tomographic angiography (38.9%), duplex ultrasound (3.1%), and angiography (10.7%). Arterial injuries included transection (24.3%), occlusion (17.3%), partial transection/flow limiting defect (24.5%), pseudoaneurysm (9.0%), and other injuries including intimal defects (22.7%). Nonoperative management was undertaken in 276 (50.9%), with failure in 4.0%. Definitive endovascular and open repair were used in 40 (7.4%) and 126 (23.2%) patients, respectively. Damage-control maneuvers were used in 57 (10.5%), including ligation (31, 5.7%) and shunting (14, 2.6%). Reintervention of initial repair was required in 42 (7.7%). Amputation was performed in 7.7% of extremity vascular injuries, and overall hospital mortality was 12.7%. Follow-up ranging from 1 month to 7 months is available for 48 patients via a variety of modalities, with reintervention required in 1 patient.

CONCLUSION The PROOVIT registry provides a contemporary picture of the management of vascular injury. This resource promises to provide needed information required to answer questions about optimal diagnosis and management of these patients—including much needed long-term outcome data.

LEVEL OF EVIDENCE Epidemiologic study, level V.

From the University of Texas Health Sciences Center–Houston (J.J.D., J.B.H.), Houston, Texas; University of Tennessee Health Sciences Center–Memphis (S.A.S., T.C.F.), Memphis, Tennessee; R Adams Cowley Shock Trauma Center (J.M., T.S., T.E.R.), University of Maryland, Baltimore, Maryland; University of Florida–Jacksonville (D.S.), Jacksonville, Florida; East Carolina Medical Center (N.P.), Benson, North Carolina; and Los Angeles County + University of Southern California Hospital (K.C., K.I.), Los Angeles, California.

Submitted: September 5, 2014, Revised: November 2, 2014, Accepted: November 4, 2014.

This study was presented at the 73rd annual meeting of the American Association for the Surgery of Trauma, September 9–13, 2014, in Philadelphia, Pennsylvania.

Address for reprints: Lt Col Joseph J. DuBose, MD, USAF, MC, 6400 Fannin St, Suite 2850 Houston, TX 77030; email: jjd3c@yahoo.com.

© 2015 Lippincott Williams & Wilkins, Inc.