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Table 1 Clinical signs for prediction of an arterial extremity injury.

From: Vascular injuries after minor blunt upper extremity trauma: pitfalls in the recognition and diagnosis of potential "near miss" injuries

"Hard signs" "Soft signs"
Active or pulsatile hemorrhage Asymmetric extremity blood pressures
Pulsatile or expanding hematoma Stable and non-pulsatile hematoma
Clinical signs of limb ischemia Proximity of wound to a major vessel
Diminished or absent pulses Peripheral neurological deficit
Bruit or thrill, suggesting AV-fistula Presence of shock/hypotension
  1. The presence of a "hard sign" of an arterial injury warrants an immediate surgical exploration with the option of an on-table angiography. In contrast, the "soft signs" are less specific in predicting a significant arterial extremity injury. In exclusive presence of a "soft sign", such as an asymmetric ankle-brachial-index, the recommended further diagnostic workup includes an angiography or CT-angiography.