Abstract

OBJECTIVE: Traumatic popliteal vascular injuries are associated with the highest risk of limb loss of all peripheral vascular injuries. There remains a need to evaluate predictors of amputation as previous scores were unable to be validated. This study aims to provide simplified scoring system that preoperatively risk stratifies patients with traumatic popliteal vascular injuries for amputation.METHODS: A review of patients sustaining traumatic popliteal artery injuries was performed. Patients requiring amputation were compared to those with limb salvage at last follow-up. 80% were randomly assigned into a training group for score generation and 20% to a testing group for validation. Significant predictors of amputation (p<0.1) in univariate analysis were included in a multivariable analysis. Those with p<0.05 in the multivariable analysis were assigned points values based on relative value of their odds ratios. ROC curves were generated to determine low vs high risk scores. AUC of >0.65 was considered adequate for validation.RESULTS: 355 patients were included, with overall amputation rate of 16%. On multivariate regression, risk factors independently associated with amputation in the final model were: SBP <90 mm Hg (OR: 3.2, p = 0.027, 1 point), associated orthopedic injury (OR: 4.9, p = 0.014, 2 points), and lack of preoperative pedal Doppler signals (OR: 5.5, p = 0.002, 2 points, or 1 point for lack of palpable pedal pulses if Doppler signal data unavailable). A score of =3 was found to maximize sensitivity (85%) and specificity (49%) for high-risk of amputation. ROC curve for the validation group had an AUC of 0.750, meeting threshold for score validation.CONCLUSIONS: POPSAVEIT score provides a simple and practical means to effectively stratify patients preoperatively into low- and high-risk categories for major amputation.

View details for DOI 10.1016/j.jvs.2021.02.015

View details for PubMedID 33639233