GCS as a predictor of mortality in patients with traumatic inferior vena cava injuries: a retrospective review of 16 cases

Introduction: Recent research has determined Glasgow Coma Scale (GCS) to be an independent predictor of mortality in patients with traumatic inferior vena cava (IVC) injuries. The aim of this study was to evaluate the use of GCS, as well as other factors previously described as determinants of mortality, in a cohort of patients presenting with traumatic IVC lesions. Methods: A 7-year retrospective review was undertaken of all trauma patients presenting to a tertiary care trauma center with trauma related IVC lesions. Factors described in the literature as associated with mortality were assessed with univariate analysis. ANOVA analysis of variance was used to compare means for continuous variables; dichotomous variables were assessed with Fischer's exact test. Logistic regression was performed on significant variables to assess determinants of mortality. Results: Sixteen patients with traumatic IVC injuries were identified, from January 2005 to December 2011. Six patients died (mortality, 37.5%); the mechanism of injury was blunt in one case (6.2%) and penetrating in the 15 others (93.7%). Seven patients underwent thoracotomy in the operating room (OR) to obtain vascular control (43.7%). Upon univariate analysis, non-survivors were significantly more likely than survivors to have lower mean arterial pressures (MAP) in the emergency room (ER) (45.6 +/- 8.6 vs. 76.5 +/- 25.4, p = 0.013), a lower GCS (8.1 +/- 4.1 vs. 14 +/- 2.8, p = 0.004), more severe injuries (ISS 60.3 +/- 3.5 vs 28.7 +/- 22.9, p = 0.0006), have undergone thoracotomy (83.3% vs. 16.6%, p = 0.024), and have a shorter operative time (105 +/- 59.8 min vs 189 +/- 65.3 min, p = 0.022). Logistic regression analysis revealed GCS as a significant inverse determinant of mortality (OR = 0.6, 0.46-0.95, p = 0.026). Other determinants of mortality by logistic regression were thoracotomy (OR = 20, 1.4-282.4, p = 0.027), and caval ligation as operative management (OR = 45, 2.28-885.6, p = 0.012). Conclusions: GCS, the need to undergo thoracotomy, and caval ligation as operative management are significant predictors of mortality in patients with traumatic IVC injuries.