A New Tool to Assess The Risk of Limb Loss Following Peripheral Vascular Injuries in Trauma Patients at The Emergency Department

Background: Recent studies have shown increased risk of limb loss and disability following peripheral vascular injuries, especially injuries associated with orthopedic and extensive soft tissue injury.
Objective: To provide an application of a simple tool that assesses the risk of limb loss following peripheral vascular injuries in trauma patients at the emergency department.
Patients and Methods: A retrospective cross-sectional study was conducted on 50 patients suffering peripheral vascular injury attending the Emergency Department at Menoufia University Hospitals and other hospitals over six months, starting from the 1^st of July 2023. All patients were followed up for amputation risk as the outcome of the study. The median follow-up period was one month.
Results: A total of 31 patients with lower limb, 25 of them were high-risk (80.6%), and 15 of them underwent an amputation (48%). A total of 19 patients with upper limb, 10 of them were high risk (52.6%), and 3 of them underwent an amputation (15.8%). The amputation rate was significantly higher among patients with lower limb injuries compared to upper limb patients. The POPSAVEIT  score was significantly important in stratifying the amputation risk of the patients, using a score of ≥3 for high-risk patients and ˂3 for low-risk patients.In our study, ROC (receiver operating characteristic) analysis shows that the POPSAVEIT score could be used as a predictive scoring system for the diagnosis of high and low-risk patients for amputation with an area under a curve of 0.829, 0.700 (p ˂.001) at 5% CI of (0.61–1.0, 0.498-0.902), using a cut-off of ≥3.5 and ≥3, with (75.1%, 80%) sensitivity and (65.3%, 70.1%) specificity for upper and lower limb vascular injury, respectively.
Conclusion: The POPSAVEIT score could be used as a predictive scoring system for the diagnosis of high and low-risk patients for amputation using a cut-off of ≥3.5 and ≥3, with (75.1%, 80%) sensitivity and (65.3%, 70.1%) specificity for upper and lower limb vascular injury, respectively.