Major Vascular and Thoracic Trauma in Nordic Populations

• Main Author: Jóhannesdóttir, Bergrós Kristín
• Other Authors: Tómas Guðbjartsson, Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, University of Iceland
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: University of Iceland, School of Health Sciences, Faculty of Medicine 2023
• Subjects: Doktorsritgerðir; Faraldsfræði; Brjóstholsskurðlækningar; Æðaskurðlækningar; Áverkar; Lifun (heilbrigðismál); Forspárgildi; Meðferð; Vascular surgery; Thoracic surgery; Epidemiology; Injury score; Survival; Predictive factor; Treatment; Bergen; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/3968

Injuries involving major arteries and the thorax are major causes of mortality and morbidity worldwide. Studies on the epidemiology of vascular trauma are scarce and preventive measures are of utmost importance, such as improved roads and safer vehicles. There is a need to better understand factors predictive of mortality in trauma patients who are admitted alive to hospitals, aiming to improve treatment outcomes and lower mortality rates. The aim of this doctoral thesis, which consists of a collection of five scientific articles, is to evaluate outcomes and prognostic factors associated with 30-day and long-term survival in patients with severe injuries to major arteries of the body in two well-defined Nordic patient cohorts, both in Iceland and Bergen. Data regarding patient demographics, mechanism and location of vascular injury and treatment, incidence, overall survival, and injury scores (Injury Severity Score [ISS], New ISS [NISS], and Trauma Score and Injury Severity Score [TRISS]) were recorded. The data were extracted from national and local trauma registries and patient charts. We also calculated Comorbidity Polypharmacy Scores and Comprehensive Complication Indexes to evaluate predictive factors for in-hospital mortality after serious thoracic trauma. In Paper I, adults (age ≥ 18 years) who sustained major vascular injuries in traffic accidents in Iceland in the years 2000–2011 were retrospectively studied. Sixty-two patients (mean age, 44 years; 79% males) sustained 95 major vascular injuries. Before admission, 41 patients died and 21 (34%) reached the hospital alive. The annual incidence for both sexes was 1.69/100 000 inhabitants. A significantly higher proportion of individuals sustained their injuries in rural vs. urban areas (69% vs. 31%, p < 0.01). Patients who died sustained thoracic (76%) or abdominal major vascular trauma (23%). Fatal cases of thoracic aortic injury were largely (77%) attributed to motor vehicle collisions and 74% occurred in rural areas. The average NISS for the 21 ...