The Effect of Associated Vascular Injuries in Penetrating Trauma to the Duodenum and Pancreas

Abstract

Objectives: Major vascular injuries contribute significantly to the mortality of pancreatic and duodenal trauma. We hypothesized that in the setting of penetrating trauma to the pancreas and/or duodenum, independent predictors of mortality associated with vascular injuries could be identified. Our objectives in this study were to describe the national profile of major vascular injuries as well as to identify predictors of morbidity and mortality. Methods: Using the abbreviated injury scale 2005 and ICD-9-CM E-codes, we identified 597 penetrating pancreatic, duodenal, and pancreaticoduodenal trauma patients with major vascular injuries from the NTDB between 2010 and 2014. We controlled patientlevel covariates of age, biological sex, systolic blood pressure (SBP), Glasgow coma score (GCS), pulse, injury severity score (ISS), and organ injury scale (OIS) grade. We estimated multivariable generalized linear mixed models to account for the nesting of patients within trauma centers. Results: Our results indicated an overall mortality rate of 26.1%. Approximately 19% of patients died within 24 hours of admission, and of those, 78% died in the first 6 hours. The inferior vena cava was the most commonly injured vessel. The average number of associated injuries was 4.9 in pancreatic or duodenal trauma and 5.4 in pancreaticoduodenal. Statistically significant independent predictors of mortality were firearm mechanism, SBP, GCS, and pulse. Specifically, odds of death were decreased with a 10-mmHg higher admission SBP (7.7% decreased odds), one-point higher GCS (12.8%), and a 10-beat lower pulse (11.6%). Conclusions: This study is the first to examine the effect of major vascular injuries in the setting of penetrating trauma to the pancreas and/or duodenum utilizing the NTDB. We have identified patterns of injury and statistically significant independent predictors of morbidity and mortality.