Editor's Choice - Vascular Trauma in England, Wales, and Ireland: An Analysis of the Trauma Audit and Research Network National Data Registry.

Abstract

To define and characterise the epidemiology, management, and outcomes of vascular trauma in the UK and Ireland following the introduction of a national major trauma network. A retrospective observational study of The Trauma Audit and Research Network registry. Patients with traumatic vascular injury between 2013 and 2020 were analysed (n = 8 357). Demographics, injury descriptors, severity score, patient management, and outcomes were analysed. The case volume increased 40.2% between 2013 (n = 780) and 2020 (n = 1 094). The median patient age was 40.6 years, and over two thirds (n = 5 758) of injuries occurred following blunt trauma. Over half of the patients were admitted in haemorrhagic shock, two thirds presenting outside normal working hours (17:00 - 08:00). From nearly 9 000 vessel injuries, 7 136 (80.6%) were arterial; the aorta was the most frequently involved vessel (n = 1 115). Interventions were carried out in 3 338 (39.9%) patients, 2 639 (73.8%) via open surgery, with a median time to theatre of 3.3 hours. Interventional radiology procedures included 616 embolisations and 319 primary stentings. The aorta was the most common site for intervention outside the extremities, 250 (88.3%) of which were stented. Overall and early mortality rates fell significantly during the study from 15.9% and 8.1% in 2013 to 11.1% and 2.9% in 2020 (r = -0.82, r = -0.90, p = .006, p = .001), respectively. Median critical care length of stay was five days, and overall hospital stay for all patients was 12 days. Following the transition towards major trauma networks, overall and early vascular trauma mortality reduced significantly. Co-operative development of national vascular and trauma registries to capture data relevant to quality improvement activity is needed to inform and shape future practice.