Guidelines for the diagnosis and management of blunt aortic injury: An east practice management guidelines work group

K. Nagy, Timothy Fabian, G. Rodman, G. Fulda, A. Rodriguez, S. Mirvis

Research output: Contribution to journalArticle

Abstract

The EAST work group was composed of trauma surgeons, thoracic surgeons, and a trauma radiologist. The literature review included a 30 year span and consisted of 137 articles. The work group applied the quality assessment instrument developed by the Brain Trauma Foundation and later adopted by the EAST Practice Management Guidelines committee. The assessment instrument provided an evidence-based guideline to classify each article. Articles were reviewed and defined within the three classes; Class 1: Insufficient evidence to support a standard of care, Class II: Prospective non-comparative clinical study or a retrospective analysis based on reliable data, Class Ill: Retrospective case series or data base review. One evidentiary table was included in the article. The work group reviewed the literature for the following questions; which patients to screen, angiography as a diagnostic test, computed tomography of the chest (CTC) as a diagnostic test, transesophageal echocardiography (TEE) as a diagnostic test, when (and if) to repair, and best technique of repair. There were no Class I recommendations made, as no articles met this level of evidence. The authors made Class II recommendations involving angiography, chest x-ray, computerized tomography of the chest, and time of repair. Only six articles were reviewed on angiography. The class II recommendation remained that angiography be considered a very sensitive accurate diagnostic tool, and a standard to which other tools should be compared. Chest x-ray was considered a good screening tool to determine the need for further work up. The authors cited widened mediastinum, obscured aortic knob, deviation of the left mainstem bronchus or nasogastic tube, and opacification of the aortopulmonary window were the most significant findings for further investigation. The authors found CTC as a useful tool for both screening and diagnoses. BAI can be ruled out with the use of a spiral or helical scanner due to their reportedly high negative predictive value. If indeterminate findings were present on CTC then angiography may be used. The literature supported prompt repair. of the injury. Delayed repair was acceptable in patients with other immediate life-threatening injuries or poor operative candidates. Control of blood pressure with beta-blockers or nitroprusside was advised in these cases until the patient was stabilized for operative intervention. Class III recommendation was applied to the use of TEE due to the limitation of experienced operators and availability. Authors agreed that the best technique for repair should employ some type of distal perfusion, either by shunt or by-pass.

Original languageEnglish (US)
JournalJournal of Trauma Nursing
Volume7
Issue number4
StatePublished - Jan 1 2000

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Nonpenetrating Wounds
Practice Management
Practice Guidelines
Thorax
Guidelines
Angiography
Tomography
Routine Diagnostic Tests
Transesophageal Echocardiography
Wounds and Injuries
X-Rays
Mediastinum
Nitroprusside
Bronchi
Standard of Care
Perfusion
Databases
Blood Pressure

All Science Journal Classification (ASJC) codes

  • Emergency
  • Critical Care
  • Advanced and Specialized Nursing

Cite this

Guidelines for the diagnosis and management of blunt aortic injury : An east practice management guidelines work group. / Nagy, K.; Fabian, Timothy; Rodman, G.; Fulda, G.; Rodriguez, A.; Mirvis, S.

In: Journal of Trauma Nursing, Vol. 7, No. 4, 01.01.2000.

Research output: Contribution to journalArticle

Nagy, K. ; Fabian, Timothy ; Rodman, G. ; Fulda, G. ; Rodriguez, A. ; Mirvis, S. / Guidelines for the diagnosis and management of blunt aortic injury : An east practice management guidelines work group. In: Journal of Trauma Nursing. 2000 ; Vol. 7, No. 4.
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