AAST Bladder Injury Scale AAST Bowel Injury Scale AAST Cardiac Injury Scale AAST Diaphragm Injury Scale AAST Hepatic Injury Scale AAST Kidney Injury Scale AAST Lung Injury Scale AAST Pancreatic Injury Scale AAST Rectal Injury Scale AAST Splenic Injury Scale AAST Vascular Injury Scale ABC Score (Massive Transfusion)ACS COT Field Triage Guidelines ATLS Hemorrhagic Shock Classification Abbreviated Injury Scale (AIS)Ankle-Brachial Index (ABI) in Trauma Base Deficit in Trauma Brain Injury Guidelines (BIG) Score Cardiac Wound Index Chest Trauma Score (CTS)Damage Control Decision Score (DCDS)Denver Criteria (BCVI)Esophageal Perforation Severity Score (PSS)Expanded Denver Criteria (BCVI)Flint Colon Injury Scale Frailty Index in Trauma (mFI-5)Geriatric Trauma Outcome Score (GTOS)Hard Signs of Vascular Injury Checklist Hemorrhage Control Decision Aid (Wound Packing vs. Tourniquet)ICP-based Cerebral Perfusion Pressure (CPP) Calculator Injury Severity Score (ISS)Injury Severity Score — Age-adjusted (ISS-Age)Lethal Triad / Trauma Triad of Death Calculator Limb Salvage Index (LSI)Mangled Extremity Severity Score (MESS)Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP)Memphis Criteria (BCVI)Modified Shock Index (MSI)Nerve Injury, Ischemia, Soft-tissue, Skeletal Injury, Shock, Age (NISSSA)New Injury Severity Score (NISS)Open Abdomen Classification (Björck)Pediatric Trauma Score (PTS)Pelvic Trauma Hemorrhage Risk Score Penetrating Abdominal Trauma Index (PATI)Physiologic Extreme Emergency in Trauma (FEET)Predictive Salvage Index (PSI)REBOA Zone Selection Guide Resuscitative Thoracotomy Indications (EAST/WTA Guidelines)Revised Trauma Score (RTS)RibScore Shock Index (SI)TASH Score TRISS Index Thoracic Trauma Severity Score (TTS)Tile Classification of Pelvic Fractures Trauma and Injury Severity Score — Pediatric (PTS)Young–Burgess Pelvic Fracture Classification

Hard Signs of Vascular Injury Checklist

Vascular Evaluation

Hard Signs (Mandatory OR)

Soft Signs (Imaging Indicated)

Select Findings

Toggle the clinical findings to determine the next step in vascular management.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

In the setting of penetrating or blunt extremity trauma, vascular injuries are categorized into "Hard Signs" and "Soft Signs." The presence of any single Hard Sign is 92-95% predictive of a major vascular injury requiring operative repair. In these cases, the delay caused by obtaining a CTA (Computed Tomography Angiography) can lead to irreversible limb ischemia or exsanguination.

Category	Clinical Findings	Management Pathway
Hard Signs	Pulsatile hemorrhage, Bruit/Thrill, Expanding hematoma, Pulselessness	Immediate OR
Soft Signs	History of hemorrhage, Proximity to vessel, Stable hematoma, Nerve deficit	CTA or ABI first
Asymptomatic	No physical findings, distal pulses intact	Observation or ABI

Last Comprehensive Review: 2026

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