Determinants of survival after inferior vena cava trauma

Inferior vena cava (IVC) injuries continue to be associated with mortality rates of 21 to 66 per cent despite advances in prehospital, surgical, and c ritical care. The purpose of this study was to evaluate outcome of patients with IVC injury after treatment at a major urban trauma center and to iden tify factors predictive of survival. Between 1989 and 1995, 158 patients pr esented to the Los Angeles County + University of Southern California Medic al Center with IVC injuries. One hundred thirty-six patient records were av ailable for review and 69 data points were collected and analyzed. Mean age was 26 years (range, 6-54), and 122 (90%) patients were male. Mechanism of injury included gunshot in 88 (65%) patients, stab in 23 (17%) patients, s hotgun in 7 (5%) patients, and blunt trauma in 18 (13%) patients. The mean Injury Severity Score was 25. Seventy (52%) patients were hypotensive. Elev en (8%) patients died before surgical intervention, and 25 (18%) patients d ied before operative repair. Repair (79), ligation (20), or observation (1) was accomplished in 100 (74%) patients. Overall survival was 48 per cent a nd 65 per cent in the 100 patients surviving to operative repair, including 5 of 20 patients requiring IVC ligation. Significant differences (P < 0.00 1) between survivors and nonsurvivors included Injury Severity Score, Glasg ow Coma Score, hematocrit, hypotension, emergent thoracotomy, blood loss, l evel of injury, tamponade, and associated aortic injury. Logistic regressio n analysis identified hypotension, anatomic level of injury, and associated aortic injury as significant predictors of outcome (P = 0.001). Survival i s predominantly determined by severity and anatomic accessibility of the IV C injury and by the absence of associated major vascular injuries. Ligation may control otherwise exsanguinating injuries and should be considered ear ly in the management of complex injuries.