Global Disparity Within the Management of Traumatic Abdominal Vascular Injuries: Analysis of a Global Dataset.

Abstract

Background: Vascular injuries are common to trauma and carry a high risk to limb and life. Integrating specialist vascular care into existing trauma systems is essential; however, global data on this topic remains limited. This study describes global patterns of abdominal vascular trauma, through secondary analysis of the Global Outcomes After Laparotomy for Trauma (GOAL-Trauma) study dataset, examining system- and patient-level differences across resource settings.

Methods: Patients of any age with blunt or penetrating trauma who underwent an abdominal vascular procedure during trauma laparotomy were included. Patient characteristics, injury patterns, peri-operative factors, and outcomes were recorded. Data were summarized using descriptive statistics and differences across Human Development Index (HDI) tertiles were analyzed with the Kruskal-Wallis or χ² tests, where appropriate.

Results: A total of 178 patients from 82 hospitals across 33 countries were included, representing one in 10 patients (178 of 1769) of the original dataset. A higher proportion of patients had vascular procedures in the upper HDI tertile (64 of 492, 13.0%), compared to middle (82 of 714, 11.5%) and lower (32 of 563, 5.7%) HDI tertiles. The median time from injury to operation was 5.0 hours (IQR 2.0-9.0). Among patients who were hypotensive on presentation, time from arrival to operation was significantly longer in the lower HDI tertile (p = 0.033). The most common regions of vascular injury were the inferior vena cava (37 patients, 20.8%) and iliac vein (30 patients, 16.9%). Thirty day post-operative mortality was 17.4% (31 of 178 patients), with only around half of the patients (94 of 178, 52.8%) discharged to their usual place of residence.

Conclusions: As trauma systems become integrated into national healthcare services, prioritizing vascular care is crucial. There remains considerable variation in the provision of vascular services in trauma globally, yet given the time-critical nature of vascular injuries, it is essential to ensure effective, integrated care pathways.