Vascular Interventions and Surgery in Trauma Audit (VISTA)

Dear Editor In the UK, major trauma remains the leading cause of death in the first four decades of life, with exsanguination being the primary cause of preventable death1,2. Major trauma also represents the most common cause of limb loss amongst young adults1,2. Despite these patients having a mortality rate in excess of 10 per cent, there is no national registry of incidence, procedural key performance indicators or clinical outcomes. Whilst the Trauma Audit and Research Network (TARN) collects data pertaining to vascular injury, it lacks the granularity to allow detailed evaluation of management strategies, patient pathways and outcomes3. The National Vascular Registry (NVR) excludes patients with traumatic vascular injury. Accurate and comprehensive data collected across the whole patient pathway is critical to understand the current incidence, contemporary management and outcomes associated with vascular trauma in the UK. Due to the relatively low incidence of vascular injury, a large, multicentre audit is required to determine the national burden of vascular injury and current practice. The primary aim of the Vascular Interventions and Surgery in Trauma Audit (VISTA) is to determine the current UK incidence of vascular trauma and compare management with guidelines produced by the American Association of Surgery for Trauma and the Eastern Association for the Surgery of Trauma4,5. The secondary aims are to describe the associated patient outcomes and current patient pathways. VISTA is a national, multicentre, prospective, collaborative, trainee-led audit by the National Trauma Research and Innovation Collaborative (NaTRIC) and the Vascular and Endovascular Research Network (VERN)—the first such collaboration between these two research networks (full protocol in Appendix S2). All major trauma centres in the UK were invited to participate in VISTA; 30 of 31 centres have been recruited and commenced data collection in March and April 2022 for a consecutive 6-month period (condensed data points Table 1). All patients with radiologically, and/or intraoperatively proven vascular injury in the UK were eligible for inclusion. Patients with isolated intracranial and/or coronary vessel injuries, iatrogenic injuries, isolated injuries to the superficial venous system and isolated injuries to vessels distal to the popliteal trifurcation or brachial bifurcation were excluded. The end of patient level follow-up is defined as the point at which the patient either dies, is discharged from hospital or reaches day 30 of their inpatient stay. Data were collected by each recruited site and entered into a centrally managed database using the Research Electronic Data Capture (REDCap) system (Table S1). Each centre needed local approval from their audit and Caldicott guardian before commencing data collection but ethics approval was not required. The results of the study will be disseminated to each site, submitted for presentation at academic conferences and will be submitted for peer-reviewed publication. A collaborative authorship model will be employed for both presentation and publication (full protocol in Appendix S2). Complete list of data points to be collected ED, emergency department. See Supplementary material for more detail. Complete list of data points to be collected ED, emergency department. See Supplementary material for more detail. VISTA is an innovative project that will capture important data on the state of vascular trauma care in the UK and hopes to inform improvements in vascular trauma management. Having recruited all but one major trauma centre in the UK with 309 patients entered into REDCap to date (December 2022), the data will be widely applicable, allowing comparison of current management and will identify any geosocial disparities that may exist. As no current UK-specific guidelines exist on the management of vascular trauma, it is expected that the results of this study will inform the design of future studies and development of national guidelines. G. K. Ambler (University of Bristol, Bristol UK); L. Hitchman (Hull-York Medical School, Hull, UK); R. A. Benson (University of Otago, Department of Academic Surgery, Christchurch, New Zealand); P. Birmpili (Hull York Medical School, Hull, UK); R. H. J. Blair (Royal Victoria Hospital, Belfast, UK); D. C. Bosanquet (Aneurin Bevan University Health Board, Newport, UK); N. Dattani (University Hospital of Leicester, Leicester, UK); G. Dovell (University of Bristol, Bristol, UK); B. L. Gwilym (Aneurin Bevan University Health Board, Newport, UK); M. Machin (Imperial College, London, UK); S. Nandhra (Northern Vascular Centre, Freeman Hospital, Newcastle, UK); S. Onida (Imperial College, London, UK); J. Shalhoub (Imperial College, London, UK); A. A. Singh (University of Cambridge, Cambridge, UK); A. Saratzis (University of Leicester, Leicester, UK); J. Wohlgemut (Centre for Trauma Sciences, Blizard Institute, Queen Mary University, London, UK); M. Marsden (Centre for Trauma Sciences, Blizard Institute, Queen Mary University, London, UK); J. Ross (Centre for Trauma Sciences, Blizard Institute, Queen Mary University, London, UK); P. Vulliamy (Centre for Trauma Sciences, Blizard Institute, Queen Mary University, London, UK); A. Rossetto (Centre for Trauma Sciences, Blizard Institute, Queen Mary University, London, UK); R. Carden (Centre for Trauma Sciences, Blizard Institute, Queen Mary University, London, UK). The project has been awarded funding from the Circulation Foundation UK and the Newcastle Hospitals Charity. Supplementary material is available at BJS Open online. This paper is not based on previous communication to a society or meeting. The authors of this paper have no conflicts to declare. The data used in this paper is widely accessible to the public and may be accessed via the references at the end of the article. Katherine-Helen Hurndall (Conceptualization, Funding acquisition, Project administration, Writing—original draft, Writing—review & editing), Hannah Merriman (Project administration, Writing—original draft), Robert Leatherby (Project administration, Writing—review & editing), Simon Glasgow (Conceptualization, Supervision) and Ross Davenport (Conceptualization, Supervision, Writing—review & editing).