3%) [5]. Nonetheless, in our patient cohort presenting with a high incidence of penetrating IVC trauma (93.7%), logistic regression confirmed GCS is significantly associated with mortality. In our cohort, patients did not sustain major head injuries, thus the significant association GCS demonstrated with mortality likely reflects substantial hemodynamic compromise, as has been previously proposed [5]. The other determinants
of mortality in our regression model were thoracotomy and to have undergone IVC ligation instead of simple suture repair. The use of thoracotomy to obtain vascular control likely suggests more extensive vascular injuries, which is consistent with the fact non-survivors had significantly more severe injuries as expressed by a higher ISS. Significantly better survival has been previously GSK1838705A clinical trial described in IVC injuries treated with IVC ligation [1], and thus our results must be interpreted with selleck screening library caution. However, in our cohort IVC ligation was utilized as a salvage method to treat vascular injuries not amenable to primary repair or when the surgical team faced difficulty in obtaining adequate exposure in a patient at risk of exsanguination. Patients treated with IVC
ligation had more severe injuries as reflected by a significantly higher ISS (Table 3). Our study has several limitations, including our small sample size and its retrospective nature. However our results are relevant as we confirm GCS as a predictor of mortality in patients with traumatic IVC injuries. This study, along with others, point to the relevance of GCS as a predictor of mortality in patients with IVC trauma, of both blunt and penetrating etiology. Further prospective studies are needed to confirm the validity of GCS along with other previously described determinants of mortality in IVC trauma. Likewise, management protocols need be established to decrease the high
mortality rate that is still seen with traumatic IVC injuries, which has not improved in spite of improved resuscitation and pre-hospital care. Conclusions In spite of being a relatively rare event, trauma related IVC injuries present a formidable challenge to the trauma surgeon, with a high overall mortality rate of 43%, which has not changed in recent years despite vast G protein-coupled receptor kinase improvements in pre-hospital transport time and care, hospital resuscitation and surgical critical care. Our results confirm GCS is an independent predictor of mortality in IVC trauma. Other significant determinants of mortality in our cohort were the use of thoracotomy, and the use of IVC ligation as operative management. Further prospective studies are needed to confirm the validity of the described determinants of mortality in IVC trauma. Management protocols need be established to decrease the high mortality rate still carried by traumatic IVC injuries. References 1. Kuehne J, Frankhouse J, Modrall G, Golshani S, Aziz I, Demetriades D: Determinants of survival after inferior vena cava trauma.