Prospective study of blunt aortic injury: Helical CT is diagnostic and antihypertensive therapy reduces rupture

Timothy C. Fabian, Kimberly A. Davis, Morris L. Gavant, Martin Croce, Sherry M. Melton, Joe H. Patton, Constance K. Haan, Darryl S. Weiman, James W. Pate

Research output: Contribution to journalArticle

240 Citations (Scopus)

Abstract

Objective: There were two aims of this study. The first was to evaluate the application of helical computed tomography of the thorax (HCTT) for the diagnosis of blunt aortic injury (BAI). The second was to evaluate the efficacy of β-blockers with or without nitroprusside in preventing aortic rupture. Summary Background Data: Aortography has been the standard for diagnosing BAI for the past 4 decades. Conventional chest CT has not proven to be of significant value. Helical CT scanning is faster and has higher resolution than conventional CT. Retrospective studies have suggested the efficacy of antihypertensives in preventing aortic rupture. Methods: A prospective study comparing HCTT to aortography in the diagnosis of BAI was performed. A protocol of β-blockers with or without nitroprusside was also examined for efficacy in preventing rupture before aortic repair and in allowing delayed repair in patients with significant associated injuries. Results: Over a period of 4 years, 494 patients were studied. BAI was diagnosed in 71 patients. Sensitivity was 100% for HCTT versus 92% for aortography. Specificity was 83% for HCTT versus 99% for aortography. Accuracy was 86% for HCTT versus 97% for aortography. Positive predictive value was 50% for HCTT versus 97% for aortography. Negative predictive value was 100% for HCTT versus 97% for aortography. No patient had spontaneous rupture in this study. Conclusions: HCTT is sensitive for diagnosing intimal injuries and pseudoaneurysms. Patients without direct HCTT evidence of BAI require no further evaluation. Aortography can be reserved for indeterminate HCTT scans. Early diagnosis with HCTT and presumptive treatment with the antihypertensive regimen eliminated in-hospital aortic rupture.

Original languageEnglish (US)
Pages (from-to)666-677
Number of pages12
JournalAnnals of Surgery
Volume227
Issue number5
DOIs
StatePublished - May 1 1998

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Nonpenetrating Wounds
Spiral Computed Tomography
Antihypertensive Agents
Aortography
Rupture
Thorax
Prospective Studies
Aortic Rupture
Therapeutics
Nitroprusside
Tunica Intima
Spontaneous Rupture
False Aneurysm
Wounds and Injuries
Early Diagnosis
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Prospective study of blunt aortic injury : Helical CT is diagnostic and antihypertensive therapy reduces rupture. / Fabian, Timothy C.; Davis, Kimberly A.; Gavant, Morris L.; Croce, Martin; Melton, Sherry M.; Patton, Joe H.; Haan, Constance K.; Weiman, Darryl S.; Pate, James W.

In: Annals of Surgery, Vol. 227, No. 5, 01.05.1998, p. 666-677.

Research output: Contribution to journalArticle

Fabian, TC, Davis, KA, Gavant, ML, Croce, M, Melton, SM, Patton, JH, Haan, CK, Weiman, DS & Pate, JW 1998, 'Prospective study of blunt aortic injury: Helical CT is diagnostic and antihypertensive therapy reduces rupture', Annals of Surgery, vol. 227, no. 5, pp. 666-677. https://doi.org/10.1097/00000658-199805000-00007
Fabian, Timothy C. ; Davis, Kimberly A. ; Gavant, Morris L. ; Croce, Martin ; Melton, Sherry M. ; Patton, Joe H. ; Haan, Constance K. ; Weiman, Darryl S. ; Pate, James W. / Prospective study of blunt aortic injury : Helical CT is diagnostic and antihypertensive therapy reduces rupture. In: Annals of Surgery. 1998 ; Vol. 227, No. 5. pp. 666-677.
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abstract = "Objective: There were two aims of this study. The first was to evaluate the application of helical computed tomography of the thorax (HCTT) for the diagnosis of blunt aortic injury (BAI). The second was to evaluate the efficacy of β-blockers with or without nitroprusside in preventing aortic rupture. Summary Background Data: Aortography has been the standard for diagnosing BAI for the past 4 decades. Conventional chest CT has not proven to be of significant value. Helical CT scanning is faster and has higher resolution than conventional CT. Retrospective studies have suggested the efficacy of antihypertensives in preventing aortic rupture. Methods: A prospective study comparing HCTT to aortography in the diagnosis of BAI was performed. A protocol of β-blockers with or without nitroprusside was also examined for efficacy in preventing rupture before aortic repair and in allowing delayed repair in patients with significant associated injuries. Results: Over a period of 4 years, 494 patients were studied. BAI was diagnosed in 71 patients. Sensitivity was 100{\%} for HCTT versus 92{\%} for aortography. Specificity was 83{\%} for HCTT versus 99{\%} for aortography. Accuracy was 86{\%} for HCTT versus 97{\%} for aortography. Positive predictive value was 50{\%} for HCTT versus 97{\%} for aortography. Negative predictive value was 100{\%} for HCTT versus 97{\%} for aortography. No patient had spontaneous rupture in this study. Conclusions: HCTT is sensitive for diagnosing intimal injuries and pseudoaneurysms. Patients without direct HCTT evidence of BAI require no further evaluation. Aortography can be reserved for indeterminate HCTT scans. Early diagnosis with HCTT and presumptive treatment with the antihypertensive regimen eliminated in-hospital aortic rupture.",
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AU - Davis, Kimberly A.

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AU - Croce, Martin

AU - Melton, Sherry M.

AU - Patton, Joe H.

AU - Haan, Constance K.

AU - Weiman, Darryl S.

AU - Pate, James W.

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N2 - Objective: There were two aims of this study. The first was to evaluate the application of helical computed tomography of the thorax (HCTT) for the diagnosis of blunt aortic injury (BAI). The second was to evaluate the efficacy of β-blockers with or without nitroprusside in preventing aortic rupture. Summary Background Data: Aortography has been the standard for diagnosing BAI for the past 4 decades. Conventional chest CT has not proven to be of significant value. Helical CT scanning is faster and has higher resolution than conventional CT. Retrospective studies have suggested the efficacy of antihypertensives in preventing aortic rupture. Methods: A prospective study comparing HCTT to aortography in the diagnosis of BAI was performed. A protocol of β-blockers with or without nitroprusside was also examined for efficacy in preventing rupture before aortic repair and in allowing delayed repair in patients with significant associated injuries. Results: Over a period of 4 years, 494 patients were studied. BAI was diagnosed in 71 patients. Sensitivity was 100% for HCTT versus 92% for aortography. Specificity was 83% for HCTT versus 99% for aortography. Accuracy was 86% for HCTT versus 97% for aortography. Positive predictive value was 50% for HCTT versus 97% for aortography. Negative predictive value was 100% for HCTT versus 97% for aortography. No patient had spontaneous rupture in this study. Conclusions: HCTT is sensitive for diagnosing intimal injuries and pseudoaneurysms. Patients without direct HCTT evidence of BAI require no further evaluation. Aortography can be reserved for indeterminate HCTT scans. Early diagnosis with HCTT and presumptive treatment with the antihypertensive regimen eliminated in-hospital aortic rupture.

AB - Objective: There were two aims of this study. The first was to evaluate the application of helical computed tomography of the thorax (HCTT) for the diagnosis of blunt aortic injury (BAI). The second was to evaluate the efficacy of β-blockers with or without nitroprusside in preventing aortic rupture. Summary Background Data: Aortography has been the standard for diagnosing BAI for the past 4 decades. Conventional chest CT has not proven to be of significant value. Helical CT scanning is faster and has higher resolution than conventional CT. Retrospective studies have suggested the efficacy of antihypertensives in preventing aortic rupture. Methods: A prospective study comparing HCTT to aortography in the diagnosis of BAI was performed. A protocol of β-blockers with or without nitroprusside was also examined for efficacy in preventing rupture before aortic repair and in allowing delayed repair in patients with significant associated injuries. Results: Over a period of 4 years, 494 patients were studied. BAI was diagnosed in 71 patients. Sensitivity was 100% for HCTT versus 92% for aortography. Specificity was 83% for HCTT versus 99% for aortography. Accuracy was 86% for HCTT versus 97% for aortography. Positive predictive value was 50% for HCTT versus 97% for aortography. Negative predictive value was 100% for HCTT versus 97% for aortography. No patient had spontaneous rupture in this study. Conclusions: HCTT is sensitive for diagnosing intimal injuries and pseudoaneurysms. Patients without direct HCTT evidence of BAI require no further evaluation. Aortography can be reserved for indeterminate HCTT scans. Early diagnosis with HCTT and presumptive treatment with the antihypertensive regimen eliminated in-hospital aortic rupture.

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