Practical application of bedside diagnostics in determining limb viability

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; ankle-brachial indices; ankle-brachial pressure; toe-brachial pressure; trauma; vascular lab studies.