Outcome after blunt traumatic thoracic aortic laceration: Identification of a high-risk cohort

P. C. Camp; S. R. Shackford; Ronald P. Fischer; Eric Peden; David B. Hoyt; Mark A. Healy; Steven E. Ross; Michael A. Grosso; M. Margaret Knudson; Mark G. Tellez; James W. Davis; Manual Lorenzo; Mark T. Metzdorff; Paul B. Harrison; Diana Lippoldt; George E. Pierce; Geoffrey L. Bloomfield; Harvey Sugerman; M. Gage Ochsner; Barry C. Esrig; Troy Lamar; Jeffrey Landerscasper; T. H. Cogbill; H. Leon Pachter; Amber A. Guth

doi:10.1097/00005373-199709000-00004

Outcome after blunt traumatic thoracic aortic laceration: Identification of a high-risk cohort

P. C. Camp, S. R. Shackford^*, Ronald P. Fischer, Eric Peden, David B. Hoyt, Mark A. Healy, Steven E. Ross, Michael A. Grosso, M. Margaret Knudson, Mark G. Tellez, James W. Davis, Manual Lorenzo, Mark T. Metzdorff, Paul B. Harrison, Diana Lippoldt, George E. Pierce, Geoffrey L. Bloomfield, Harvey Sugerman, M. Gage Ochsner, Barry C. EsrigTroy Lamar, Jeffrey Landerscasper, T. H. Cogbill, H. Leon Pachter, Amber A. Guth

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

60 Scopus citations

Abstract

Background: Specific cohorts of patients with blunt traumatic thoracic aortic laceration (BTTAL) might benefit from conservative or delayed management. We hypothesized that age and comorbidities would predict outcome. Methods: BTTAL data from 14 trauma centers over 11 years. Hospital and autopsy records of confirmed BTTAL were retrospectively reviewed. Regression analysis evaluated outcome by trauma indices, age, premorbidities, interventions, adjuvant therapy, and delay of repair. Results: Three hundred ninety-five cases of BTTAL were identified, 233 who were stable. Stable cohort survival was 71.9%. No trauma indices predicted outcome. Comorbidities, especially coronary artery disease (CAD), were associated with mortality. The use of β-blocking agents and maintenance of normal blood pressure were associated with survival. Delay of >4 hours to operative repair was not associated with increased mortality. Increasing age was associated with higher mortality. Multivariate regression found CAD and AGE predictive of mortality (log odds formula: exp [-2.0858 + 0.0253(AGE) + 2.0428(CAD)]). Conclusions: AGE and CAD are associated with worse outcome in stable BTTAL patients undergoing operative repair. Treating comorbidities and managing associated injuries should be undertaken in stable BTTAL patients. Physiologic stability should be established before repair of BTTAL.

Original language	English
Pages (from-to)	413-422
Number of pages	10
Journal	Journal of Trauma - Injury, Infection and Critical Care
Volume	43
Issue number	3
DOIs	https://doi.org/10.1097/00005373-199709000-00004
State	Published - Sep 1997
Externally published	Yes

Keywords

Age
Blunt aortic laceration
Comorbidity
Management
Trauma
β-blockers

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10.1097/00005373-199709000-00004

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Camp, P. C., Shackford, S. R., Fischer, R. P., Peden, E., Hoyt, D. B., Healy, M. A., Ross, S. E., Grosso, M. A., Knudson, M. M., Tellez, M. G., Davis, J. W., Lorenzo, M., Metzdorff, M. T., Harrison, P. B., Lippoldt, D., Pierce, G. E., Bloomfield, G. L., Sugerman, H., Ochsner, M. G., ... Guth, A. A. (1997). Outcome after blunt traumatic thoracic aortic laceration: Identification of a high-risk cohort. Journal of Trauma - Injury, Infection and Critical Care, 43(3), 413-422. https://doi.org/10.1097/00005373-199709000-00004

@article{7601156ddef24b20b93a38c410bc75b3,

title = "Outcome after blunt traumatic thoracic aortic laceration: Identification of a high-risk cohort",

abstract = "Background: Specific cohorts of patients with blunt traumatic thoracic aortic laceration (BTTAL) might benefit from conservative or delayed management. We hypothesized that age and comorbidities would predict outcome. Methods: BTTAL data from 14 trauma centers over 11 years. Hospital and autopsy records of confirmed BTTAL were retrospectively reviewed. Regression analysis evaluated outcome by trauma indices, age, premorbidities, interventions, adjuvant therapy, and delay of repair. Results: Three hundred ninety-five cases of BTTAL were identified, 233 who were stable. Stable cohort survival was 71.9%. No trauma indices predicted outcome. Comorbidities, especially coronary artery disease (CAD), were associated with mortality. The use of β-blocking agents and maintenance of normal blood pressure were associated with survival. Delay of >4 hours to operative repair was not associated with increased mortality. Increasing age was associated with higher mortality. Multivariate regression found CAD and AGE predictive of mortality (log odds formula: exp [-2.0858 + 0.0253(AGE) + 2.0428(CAD)]). Conclusions: AGE and CAD are associated with worse outcome in stable BTTAL patients undergoing operative repair. Treating comorbidities and managing associated injuries should be undertaken in stable BTTAL patients. Physiologic stability should be established before repair of BTTAL.",

keywords = "Age, Blunt aortic laceration, Comorbidity, Management, Trauma, β-blockers",

author = "Camp, {P. C.} and Shackford, {S. R.} and Fischer, {Ronald P.} and Eric Peden and Hoyt, {David B.} and Healy, {Mark A.} and Ross, {Steven E.} and Grosso, {Michael A.} and Knudson, {M. Margaret} and Tellez, {Mark G.} and Davis, {James W.} and Manual Lorenzo and Metzdorff, {Mark T.} and Harrison, {Paul B.} and Diana Lippoldt and Pierce, {George E.} and Bloomfield, {Geoffrey L.} and Harvey Sugerman and Ochsner, {M. Gage} and Esrig, {Barry C.} and Troy Lamar and Jeffrey Landerscasper and Cogbill, {T. H.} and Pachter, {H. Leon} and Guth, {Amber A.}",

year = "1997",

month = sep,

doi = "10.1097/00005373-199709000-00004",

language = "English",

volume = "43",

pages = "413--422",

journal = "Journal of Trauma - Injury, Infection and Critical Care",

issn = "0022-5282",

number = "3",

}

Camp, PC, Shackford, SR, Fischer, RP, Peden, E, Hoyt, DB, Healy, MA, Ross, SE, Grosso, MA, Knudson, MM, Tellez, MG, Davis, JW, Lorenzo, M, Metzdorff, MT, Harrison, PB, Lippoldt, D, Pierce, GE, Bloomfield, GL, Sugerman, H, Ochsner, MG, Esrig, BC, Lamar, T, Landerscasper, J, Cogbill, TH, Pachter, HL & Guth, AA 1997, 'Outcome after blunt traumatic thoracic aortic laceration: Identification of a high-risk cohort', Journal of Trauma - Injury, Infection and Critical Care, vol. 43, no. 3, pp. 413-422. https://doi.org/10.1097/00005373-199709000-00004

TY - JOUR

T1 - Outcome after blunt traumatic thoracic aortic laceration

T2 - Identification of a high-risk cohort

AU - Camp, P. C.

AU - Shackford, S. R.

AU - Fischer, Ronald P.

AU - Peden, Eric

AU - Hoyt, David B.

AU - Healy, Mark A.

AU - Ross, Steven E.

AU - Grosso, Michael A.

AU - Knudson, M. Margaret

AU - Tellez, Mark G.

AU - Davis, James W.

AU - Lorenzo, Manual

AU - Metzdorff, Mark T.

AU - Harrison, Paul B.

AU - Lippoldt, Diana

AU - Pierce, George E.

AU - Bloomfield, Geoffrey L.

AU - Sugerman, Harvey

AU - Ochsner, M. Gage

AU - Esrig, Barry C.

AU - Lamar, Troy

AU - Landerscasper, Jeffrey

AU - Cogbill, T. H.

AU - Pachter, H. Leon

AU - Guth, Amber A.

PY - 1997/9

Y1 - 1997/9

N2 - Background: Specific cohorts of patients with blunt traumatic thoracic aortic laceration (BTTAL) might benefit from conservative or delayed management. We hypothesized that age and comorbidities would predict outcome. Methods: BTTAL data from 14 trauma centers over 11 years. Hospital and autopsy records of confirmed BTTAL were retrospectively reviewed. Regression analysis evaluated outcome by trauma indices, age, premorbidities, interventions, adjuvant therapy, and delay of repair. Results: Three hundred ninety-five cases of BTTAL were identified, 233 who were stable. Stable cohort survival was 71.9%. No trauma indices predicted outcome. Comorbidities, especially coronary artery disease (CAD), were associated with mortality. The use of β-blocking agents and maintenance of normal blood pressure were associated with survival. Delay of >4 hours to operative repair was not associated with increased mortality. Increasing age was associated with higher mortality. Multivariate regression found CAD and AGE predictive of mortality (log odds formula: exp [-2.0858 + 0.0253(AGE) + 2.0428(CAD)]). Conclusions: AGE and CAD are associated with worse outcome in stable BTTAL patients undergoing operative repair. Treating comorbidities and managing associated injuries should be undertaken in stable BTTAL patients. Physiologic stability should be established before repair of BTTAL.

AB - Background: Specific cohorts of patients with blunt traumatic thoracic aortic laceration (BTTAL) might benefit from conservative or delayed management. We hypothesized that age and comorbidities would predict outcome. Methods: BTTAL data from 14 trauma centers over 11 years. Hospital and autopsy records of confirmed BTTAL were retrospectively reviewed. Regression analysis evaluated outcome by trauma indices, age, premorbidities, interventions, adjuvant therapy, and delay of repair. Results: Three hundred ninety-five cases of BTTAL were identified, 233 who were stable. Stable cohort survival was 71.9%. No trauma indices predicted outcome. Comorbidities, especially coronary artery disease (CAD), were associated with mortality. The use of β-blocking agents and maintenance of normal blood pressure were associated with survival. Delay of >4 hours to operative repair was not associated with increased mortality. Increasing age was associated with higher mortality. Multivariate regression found CAD and AGE predictive of mortality (log odds formula: exp [-2.0858 + 0.0253(AGE) + 2.0428(CAD)]). Conclusions: AGE and CAD are associated with worse outcome in stable BTTAL patients undergoing operative repair. Treating comorbidities and managing associated injuries should be undertaken in stable BTTAL patients. Physiologic stability should be established before repair of BTTAL.

KW - Age

KW - Blunt aortic laceration

KW - Comorbidity

KW - Management

KW - Trauma

KW - β-blockers

UR - http://www.scopus.com/inward/record.url?scp=0030762308&partnerID=8YFLogxK

U2 - 10.1097/00005373-199709000-00004

DO - 10.1097/00005373-199709000-00004

M3 - Article

C2 - 9314301

AN - SCOPUS:0030762308

SN - 0022-5282

VL - 43

SP - 413

EP - 422

JO - Journal of Trauma - Injury, Infection and Critical Care

JF - Journal of Trauma - Injury, Infection and Critical Care

IS - 3

ER -

Outcome after blunt traumatic thoracic aortic laceration: Identification of a high-risk cohort

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Keywords

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