Original Article
Practical application of bedside diagnostics in determining limb viability
Vascular 2015, Vol. 23(2) 151–153 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1708538114540144 vas.sagepub.com
Anahita Dua1,2, Sapan S Desai3 and Sheila Coogan3
Abstract Introduction: This study aimed to determine the practical application of vascular lab studies in determining limb salvage outcomes in injured patients with concerning clinical examinations. Methods: A retrospective review of the trauma registry at a level I center was conducted from January 2009 to June 2013. All patients >16 years of age who sustained a lower limb arterial injury had a concerning clinical exam (mottled skin, decreased skin warmth, diminished pulses) and had vascular lab studies to determine management were included. Data-points included demographics, type and location of injury, procedure type, vascular lab study results, and limb outcome. Results: Over a five-year period, 11 trauma patients met inclusion criteria. Five of these patients had concerning clinical exams after revascularization, and six observed patients had a concerning clinical examination during the course of their hospitalization. All 11 patients had vascular lab studies that were within normal limits. As a result of normal vascular lab studies, none of these patients underwent further imaging or intervention. None of these patients underwent amputation. Conclusion: Vascular lab studies may be utilized to determine the need for intervention and/or lower limb bypass sufficiency in patients with questionable clinical examinations post injury.
Keywords Limb salvage, vascular lab studies, ankle-brachial pressure, toe-brachial pressure, ankle-brachial indices, trauma
Introduction Contrast angiography, while the gold-standard for delineation of vascular trauma, is an invasive, costly, and time-consuming diagnostic test.1 In trauma patients with lower extremity injury, bedside ankle-brachial indices (ABIs) are regarded as both a specific and sensitive non-invasive modality by which to objectively document the presence of lower extremity perfusion.2 The Western Trauma Association guidelines support the use of physical examination in conjunction with ABI with a cutoff of 0.9 to rule out the need for further diagnostic studies such as computed tomographic angiography (CTA) or on-table angiograms.2 With an ABI cut-off of 0.9, the sensitivity and specificity have reached >95%.1,3 Hence, for the trauma population, using ABI to screen for vascular injuries while reserving further diagnostics for extremities with an ABI
Practical application of bedside diagnostics in determining limb viability
Vascular 2015, Vol. 23(2) 151–153 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1708538114540144 vas.sagepub.com
Anahita Dua1,2, Sapan S Desai3 and Sheila Coogan3
Abstract Introduction: This study aimed to determine the practical application of vascular lab studies in determining limb salvage outcomes in injured patients with concerning clinical examinations. Methods: A retrospective review of the trauma registry at a level I center was conducted from January 2009 to June 2013. All patients >16 years of age who sustained a lower limb arterial injury had a concerning clinical exam (mottled skin, decreased skin warmth, diminished pulses) and had vascular lab studies to determine management were included. Data-points included demographics, type and location of injury, procedure type, vascular lab study results, and limb outcome. Results: Over a five-year period, 11 trauma patients met inclusion criteria. Five of these patients had concerning clinical exams after revascularization, and six observed patients had a concerning clinical examination during the course of their hospitalization. All 11 patients had vascular lab studies that were within normal limits. As a result of normal vascular lab studies, none of these patients underwent further imaging or intervention. None of these patients underwent amputation. Conclusion: Vascular lab studies may be utilized to determine the need for intervention and/or lower limb bypass sufficiency in patients with questionable clinical examinations post injury.
Keywords Limb salvage, vascular lab studies, ankle-brachial pressure, toe-brachial pressure, ankle-brachial indices, trauma
Introduction Contrast angiography, while the gold-standard for delineation of vascular trauma, is an invasive, costly, and time-consuming diagnostic test.1 In trauma patients with lower extremity injury, bedside ankle-brachial indices (ABIs) are regarded as both a specific and sensitive non-invasive modality by which to objectively document the presence of lower extremity perfusion.2 The Western Trauma Association guidelines support the use of physical examination in conjunction with ABI with a cutoff of 0.9 to rule out the need for further diagnostic studies such as computed tomographic angiography (CTA) or on-table angiograms.2 With an ABI cut-off of 0.9, the sensitivity and specificity have reached >95%.1,3 Hence, for the trauma population, using ABI to screen for vascular injuries while reserving further diagnostics for extremities with an ABI
