Citation

Malgor RD, Bilfinger TV, McCormack J, Tassiopoulos AK. Ann. Vasc. Surg. 2014; 29(3): 502-510.

Affiliation

Division of Vascular, Department of Surgery, Stony Brook, NY.

Copyright

(Copyright © 2014, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1016/j.avsg.2014.10.012

PMID

25463340

Abstract

INTRODUCTION: Blunt traumatic aortic injury (BTAI) is of very rare occurrence in adolescents. The purpose of our study was to assess the clinical presentation and treatment outcomes of BTAI in this subset of patients. MATERIAL AND METHODS: We reviewed prospective data of 18 patients who were 20 years or younger with BTAI among 28,000 trauma patients from January 1993 to December 2011. Outcomes of interest were the trends on type of repair (nonoperative (NOP), open repair (OR) or endovascular treatment (ET)) and the impact of concomitant injuries using the Injury Severity Score (ISS) on early morbidity and mortality.

RESULTS: Thirteen (72%) patients with BTAI were male with a cohort median age of 16±3 years. The mechanism of trauma was caraccident in 12, pedestrian struck by car in 5 and motorcycle crash in 1. The total ISS was 46.2 ± 15.3 being the highest score the thoracic component (4.6 ± 0.6) followed by the head score (4 ± 1.2). Two (11%) patients were pronounced dead in the emergency department and other 2 succumbed within 24 hours from admission. Of those 14 (78%) who survived longer than 24 hours, the ISS was significantly lower compared to those pronounced dead earlier (37.8 ± 10.7 vs. 59.6 ± 11.6; P= 0.0009). Ten patients (71%) underwent open repair, 3 (17%) ET and other 2 (28%) patients were treated nonoperatively. The ISS was similar among all three treatment groups (OR, 33 ± 8 vs ET, 53 ± 9 vs. NOP, 51 ± 6; P=NS). No paraplegia or renal failure was noted in either ET or OR group. In-hospital and overall mortality were 21% and 39%. Of those who survived hospitalization, 8 (73%) were discharged home and 3 (27%) to a rehabilitation center.

CONCLUSIONS: The incidence of BTAI is very low in adolescents. Overall morbidity and mortality even in young patients is still considerable being mortality associated with both ISS and degree of aortic wall disruption. Young patients with BTAI who survive hospitalization have a lower ISS and often are discharge home rather than to a rehabilitation facility.

Language: en