Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, Calif. Electronic address: leighann.o'
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Southern California, Los Angeles, Calif.
J Vasc Surg. 2021 Sep;74(3):804-813.e3. doi: 10.1016/j.jvs.2021.02.015. Epub 2021 Feb 24.
Traumatic popliteal vascular injuries are associated with the highest risk of limb loss of all peripheral vascular injuries. A method to evaluate the predictors of amputation is needed because previous scores could not be validated. In the present study, we aimed to provide a simplified scoring system (POPSAVEIT [popliteal scoring assessment for vascular extremity injuries in trauma]) that could be used preoperatively to risk stratify patients with traumatic popliteal vascular injuries for amputation.
A review of patients sustaining traumatic popliteal artery injuries was performed. Patients requiring amputation were compared with those with limb salvage at the last follow-up. Of these patients, 80% were randomly assigned to a training group for score generation and 20% to a testing group for validation. Significant predictors of amputation (P < .1) on univariate analysis were included in a multivariable analysis. Those with P < .05 on multivariable analysis were assigned points according to the relative value of their odds ratios (ORs). Receiver operating characteristic curves were generated to determine low- vs high-risk scores. An area under the curve of >0.65 was considered adequate for validation.
A total of 355 patients were included, with an overall amputation rate of 16%. On multivariate regression analysis, the risk factors independently associated with amputation in the final model were as follows: systolic blood pressure <90 mm Hg (OR, 3.2; P = .027; 1 point), associated orthopedic injury (OR, 4.9; P = .014; 2 points), and a lack of preoperative pedal Doppler signals (OR, 5.5; P = .002; 2 points [or 1 point for a lack of palpable pedal pulses if Doppler signal data were unavailable]). A score of ≥3 was found to maximize the sensitivity (85%) and specificity (49%) for a high risk of amputation. The receiver operating characteristic curve for the validation group had an area under the curve of 0.750, meeting the threshold for score validation.
The POPSAVEIT score provides a simple and practical method to effectively stratify patients preoperatively into low- and high-risk major amputation categories.
外伤性腘血管损伤是所有外周血管损伤中导致肢体丧失风险最高的。需要一种评估截肢预测因素的方法，因为之前的评分方法无法得到验证。本研究旨在提供一种简化的评分系统（POPSAVEIT [创伤性腘血管损伤的血管肢体损伤评分]），可用于术前对创伤性腘血管损伤患者进行截肢风险分层。
对接受外伤性腘动脉损伤治疗的患者进行了回顾性分析。比较了需要截肢的患者与最后一次随访时肢体存活的患者。其中 80%的患者被随机分配到评分生成的训练组，20%的患者分配到验证组。单因素分析中具有截肢意义的（P<.1）显著预测因子纳入多变量分析。多变量分析中 P<.05 的因素根据其比值比（OR）的相对值分配分数。生成受试者工作特征曲线以确定低风险和高风险评分。曲线下面积>0.65 被认为具有验证能力。
共纳入 355 例患者，截肢率为 16%。多变量回归分析显示，最终模型中与截肢独立相关的危险因素如下：收缩压<90mmHg（OR，3.2；P=0.027；1 分）、合并骨科损伤（OR，4.9；P=0.014；2 分）、术前足背多普勒信号缺失（OR，5.5；P=0.002；2 分[如果多普勒信号数据不可用，则无足背脉搏触诊信号为 1 分]）。发现评分≥3 可最大限度地提高截肢高风险的敏感性（85%）和特异性（49%）。验证组的受试者工作特征曲线下面积为 0.750，满足评分验证的阈值。
POPSAVEIT 评分提供了一种简单实用的方法，可有效术前将患者分为低风险和高风险的主要截肢类别。
