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Blunt Traumatic Aortic Injury in the Panāscan Era
- Source :
- Academic Emergency Medicine. 27:291-296
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- Author(s): Yu, Louis; Baumann, Brigitte M; Raja, Ali S; Mower, William R; Langdorf, Mark I; Medak, Anthony J; Anglin, Deirdre R; Hendey, Gregory W; Nishijima, Daniel; Rodriguez, Robert M | Abstract: BACKGROUND:In the era of frequent head-to-pelvis computed tomography (CT) for adult blunt trauma evaluation, we sought to update teachings regarding aortic injury by determining 1) the incidence of aortic injury; 2) the proportion of patients with isolated aortic injury (without other concomitant thoracic injury); 3) the clinical implications of aortic injury (hospital mortality, length of stay [LOS], and rate of surgical interventions); and 4) the screening value of traditional risk factors/markers (such as high-energy mechanism and widened mediastinum on chest x-ray [CXR]) for aortic injury, compared to newer criteria from the recently developed NEXUS Chest CT decision instrument (DI). METHODS:We conducted a preplanned analysis of patients prospectively enrolled in the NEXUS Chest studies at 10 Level I trauma centers with the following inclusion criteria: age g 14nyears, blunt trauma within 6nhours of ED presentation, and receiving chest imaging duringnED trauma evaluation. RESULTS:Of 24,010 enrolled subjects, 42 (0.17%, 95% confidence interval [CI]n= 0.13% to 0.24%) had aortic injury. Most patients (79%, 95% CIn= 64% to 88%) had an associated thoracic injury, with rib fractures, pneumothorax/hemothorax, and pulmonary contusion occurring most frequently. Compared to patients without aortic injury this cohort had similar mortality (9.5%, 95% CIn= 3.8% to 22.1% vs. 5.8%, 95% CIn= 5.4% to 6.3%), longer median hospital LOS (11ndays vs. 3ndays, pnln0.01), and higher median Injury Severity Score (29 vs. 5, pnln0.001). High-energy mechanism and widened mediastinum on CXR had low sensitivity for aortic injury (76% [95% CIn= 62% to 87%] and 33% [95% CIn= 21% to 49%], respectively), compared to the NEXUS Chest CT DI (sensitivity 100% [95% CIn= 92% to 100%]). CONCLUSIONS:Aortic injury is rare in adult ED blunt trauma patients who survive to receive imaging. Most ED aortic injury patients have associated thoracic injuries and survive to hospital discharge.nWidened mediastinum on CXR and high-energy mechanism have relatively low screening sensitivity for aortic injury, but the NEXUS Chest DI detected all cases.
- Subjects :
- Adult
Male
medicine.medical_specialty
Thoracic Injuries
Wounds, Nonpenetrating
03 medical and health sciences
Injury Severity Score
0302 clinical medicine
Trauma Centers
medicine
Humans
Whole Body Imaging
Hospital Mortality
Prospective Studies
Prospective cohort study
Aorta
Aged
business.industry
Incidence
Mediastinum
030208 emergency & critical care medicine
General Medicine
Length of Stay
Middle Aged
medicine.disease
Hemothorax
Surgery
Pulmonary contusion
medicine.anatomical_structure
Pneumothorax
Blunt trauma
Case-Control Studies
Widened mediastinum
Emergency Medicine
Female
medicine.symptom
Tomography, X-Ray Computed
business
Subjects
Details
- ISSN :
- 15532712 and 10696563
- Volume :
- 27
- Database :
- OpenAIRE
- Journal :
- Academic Emergency Medicine
- Accession number :
- edsair.doi.dedup.....b37f77ba721d823dad3bb18d25c762ac