A contemporary rural trauma center experience in blunt traumatic aortic injury

Christopher A. Durham, Michael Mcnally, Frank M. Parker, William M. Bogey, Charles S. Powell, Claudia E. Goettler, Michael F. Rotondo, Michael C. Stoner

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction: Traumatic aortic injury (TAI) is a rare yet highly lethal injury associated with blunt force deceleration injury. The adoption of thoracic endovascular aortic repair (TEVAR) has become a safer option than traditional open repair. The purpose of this study is to review a rural trauma center experience with TAI. Methods: A retrospective analysis was performed, reviewing all patients who presented with TAI between 2000 and 2009. Clinical, anatomical, and procedural variables of all cases were systematically reviewed. Clinical endpoints included mortality, and aortic-related mortality, and hospital length of stay. The study population was stratified by those that underwent surgical repair (SR) and those managed medically (MM). Results: Fifty-six patients presented with blunt TAI; 35 patients (62.5%) were surgically repaired (22 open, 13 TEVAR), while 21 (37.5%) were MM. The only difference in comorbidities was a higher rate of coronary artery disease in MM. Mean hospital arrival time (SR, 188.6 ± 30.3 minutes, MM, 253 ± 65.3 minutes), aortic injury grade (SR, 2.7 ± 0.1; MM, 2.3 ± 0.2), and injury severity score were not significantly different between the groups. Head Abbreviated Injury Score (AIS) was worse in the MM group, while chest AIS was worse in the SR group (P < .05). There were nine (42.9%) deaths in the MM group, while there were only two (5.7%) in the SR group (P < .001). There was no significant difference in aortic-related mortality. Mean follow-up time was not statistically different. Conclusion: These data provide a group of stable patients to examine the management of TAI in the endovascular era. The low aortic-related mortality in the MM group demonstrates that there is time for a thorough evaluation in patients sustaining TAI who arrive without hemodynamic instability.

Original languageEnglish (US)
Pages (from-to)884-890
Number of pages7
JournalJournal of Vascular Surgery
Volume52
Issue number4
DOIs
StatePublished - Jan 1 2010
Externally publishedYes

Fingerprint

Trauma Centers
Wounds and Injuries
Mortality
Length of Stay
Thorax
Thoracic Injuries
Injury Severity Score
Deceleration
Intraoperative Complications
Craniocerebral Trauma
Comorbidity
Coronary Artery Disease
Hemodynamics
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Durham, C. A., Mcnally, M., Parker, F. M., Bogey, W. M., Powell, C. S., Goettler, C. E., ... Stoner, M. C. (2010). A contemporary rural trauma center experience in blunt traumatic aortic injury. Journal of Vascular Surgery, 52(4), 884-890. https://doi.org/10.1016/j.jvs.2010.04.068

A contemporary rural trauma center experience in blunt traumatic aortic injury. / Durham, Christopher A.; Mcnally, Michael; Parker, Frank M.; Bogey, William M.; Powell, Charles S.; Goettler, Claudia E.; Rotondo, Michael F.; Stoner, Michael C.

In: Journal of Vascular Surgery, Vol. 52, No. 4, 01.01.2010, p. 884-890.

Research output: Contribution to journalArticle

Durham, CA, Mcnally, M, Parker, FM, Bogey, WM, Powell, CS, Goettler, CE, Rotondo, MF & Stoner, MC 2010, 'A contemporary rural trauma center experience in blunt traumatic aortic injury', Journal of Vascular Surgery, vol. 52, no. 4, pp. 884-890. https://doi.org/10.1016/j.jvs.2010.04.068
Durham, Christopher A. ; Mcnally, Michael ; Parker, Frank M. ; Bogey, William M. ; Powell, Charles S. ; Goettler, Claudia E. ; Rotondo, Michael F. ; Stoner, Michael C. / A contemporary rural trauma center experience in blunt traumatic aortic injury. In: Journal of Vascular Surgery. 2010 ; Vol. 52, No. 4. pp. 884-890.
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abstract = "Introduction: Traumatic aortic injury (TAI) is a rare yet highly lethal injury associated with blunt force deceleration injury. The adoption of thoracic endovascular aortic repair (TEVAR) has become a safer option than traditional open repair. The purpose of this study is to review a rural trauma center experience with TAI. Methods: A retrospective analysis was performed, reviewing all patients who presented with TAI between 2000 and 2009. Clinical, anatomical, and procedural variables of all cases were systematically reviewed. Clinical endpoints included mortality, and aortic-related mortality, and hospital length of stay. The study population was stratified by those that underwent surgical repair (SR) and those managed medically (MM). Results: Fifty-six patients presented with blunt TAI; 35 patients (62.5{\%}) were surgically repaired (22 open, 13 TEVAR), while 21 (37.5{\%}) were MM. The only difference in comorbidities was a higher rate of coronary artery disease in MM. Mean hospital arrival time (SR, 188.6 ± 30.3 minutes, MM, 253 ± 65.3 minutes), aortic injury grade (SR, 2.7 ± 0.1; MM, 2.3 ± 0.2), and injury severity score were not significantly different between the groups. Head Abbreviated Injury Score (AIS) was worse in the MM group, while chest AIS was worse in the SR group (P < .05). There were nine (42.9{\%}) deaths in the MM group, while there were only two (5.7{\%}) in the SR group (P < .001). There was no significant difference in aortic-related mortality. Mean follow-up time was not statistically different. Conclusion: These data provide a group of stable patients to examine the management of TAI in the endovascular era. The low aortic-related mortality in the MM group demonstrates that there is time for a thorough evaluation in patients sustaining TAI who arrive without hemodynamic instability.",
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