Penetrating extremity injuries in a large Scandinavian Level-1 trauma center: a 4-year analysis of imaging methods, mechanisms of injury and clinical outcome.

BACKGROUND

To analyze penetrating extremity injuries at a Scandinavian urban Level-1 trauma center regarding incidence, mechanism of injury, imaging approach and clinical outcome.

METHODS

A retrospective study (2013-2016) of penetrating injuries to the extremities based on a Trauma Registry. Retrieved variables included patient demographics, injury characteristics, time to CT and 30-day morbidity.

RESULTS

Of 636 patients with penetrating trauma, 142 (22.3%) sustained injuries to the extremities that required imaging, surgical treatment, or observation. Median age was 25 years (15-83) and consisted mostly of males (90.8%, 129/142). Most were Level-1 trauma, 81.7%, with 28.9% multi trauma. Most common injuries were gunshot wounds (GSW, 47.9%) and stab wounds (SW, 47.2%), and lower extremities were most common (77.8%). Imaging showing arterial injury was present in 31.0%. %. CT-angiography was the most common modality 65.5% (93/142) and had excellent sensitivity for vascular injury of 100%. More than half of CTAs were negative: 60.4% in GSW compared to 53.7% in SW. GSWs were 7.4-times likelier to necessitate acute surgery compared to SWs (p = 0.0001). Surgery requiring vascular repair consisted of 19.0% and was more common in GSW 11.3% compared to SW 6.3%. Fasciotomy was performed in 5.6% of all GSW. In 1.4% there was loss of limb. The 30-day morbidity rate was 16.2%, mortality was 0%. Overall, GSW increased the odds for 30-day complications, compared to SW (Odds-ratio = 14.1, p < 0.001).

CONCLUSIONS

In a Scandinavian Level-1 Trauma Center, about every fourth to fifth admission for penetrating trauma involved penetrating extremity injuries. GSWs had a significantly higher probability for acute surgery, and higher rate of 30-day complications. The rate of arterial injury was around one third of all injuries. CTA is effective and sensitive in detecting clinically relevant vascular injuries. Half of CTAs were negative. Stratifying patients into exam-based indication for CTA is important to reduce unnecessary imaging.