Traumatic Aortic Disruption Index is Associated with Mortality and Urgency of Stent Grafting in Blunt Thoracic Aortic (Grade 3) Injuries.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: Netherlands NLM ID: 8703941 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1615-5947 (Electronic) Linking ISSN: 08905096 NLM ISO Abbreviation: Ann Vasc Surg Subsets: MEDLINE
    • Publication Information:
      Publication: <2007->: Netherlands : Elsevier
      Original Publication: Detroit : [Published by Expansion scientifique française for Annals of Vascular Surgery, Inc. and Association pour la promotion de la chirurgie vasculaire, Paris, c1986-
    • Subject Terms:
      Wounds, Nonpenetrating*/surgery ; Wounds, Nonpenetrating*/mortality ; Wounds, Nonpenetrating*/diagnostic imaging ; Vascular System Injuries*/surgery ; Vascular System Injuries*/diagnostic imaging ; Vascular System Injuries*/mortality ; Aorta, Thoracic*/surgery ; Aorta, Thoracic*/diagnostic imaging ; Aorta, Thoracic*/injuries ; Stents* ; Blood Vessel Prosthesis Implantation*/mortality ; Blood Vessel Prosthesis Implantation*/adverse effects ; Blood Vessel Prosthesis Implantation*/instrumentation ; Endovascular Procedures*/mortality ; Endovascular Procedures*/adverse effects ; Computed Tomography Angiography* ; Injury Severity Score* ; Aortography*; Humans ; Male ; Female ; Adult ; Treatment Outcome ; Middle Aged ; Time Factors ; Retrospective Studies ; Risk Factors ; Aneurysm, False/surgery ; Aneurysm, False/mortality ; Aneurysm, False/diagnostic imaging ; Predictive Value of Tests ; Young Adult ; Blood Vessel Prosthesis ; Risk Assessment ; Thoracic Injuries/surgery ; Thoracic Injuries/mortality ; Thoracic Injuries/diagnostic imaging ; Time-to-Treatment ; Clinical Decision-Making
    • Abstract:
      Background: Delayed stent grafting for blunt thoracic aortic injuries (BTAIs) is current standard of care. However, given the heterogeneity of pseudoaneurysm presentations, it is currently unclear which severe BTAIs require more urgent intervention. We hypothesize that a Traumatic Aortic Disruption Index (TADI) calculation based on sagittal computed tomography angiography imaging measurements would correlate with urgency of stent grafting.
      Methods: All patients at a level-1 trauma center with BTAIs over a 12-year period were identified. A TADI score was then calculated using the length of pseudoaneurysm (L), maximum width of pseudoaneurysm (W), and normal adjacent aortic diameter (NA). Patient presentation, injury characteristics, timing of stent grafting, and outcomes were then evaluated.
      Results: Forty-two patients were diagnosed with BTAIs. Mean age was 37.6 years, with a median injury severity score (ISS) of 29. Overall mortality was 11.9%. TADI scores ranged from 3.6 to 158.6. Compared to patients with a TADI <28, patients with TADI >28 had similar median ISS scores (34 vs. 29, P = 0.16), and rates of both traumatic brain injury (TBI; 33.3% vs. 42.0%, P = 0.53) and nonaortic hemorrhage control procedures (44.4% vs. 33.3%, P = 0.3). TADI >28 patients had a lower initial mean systolic BP (98.5 vs. 121.9, P = 0.003), more severe hypotension (lowest systolic 77.0 vs. 91.2, P = 0.034), lower initial Glasgow Coma Scale (6 vs. 13, P = 0.039), higher mean admission lactate (4.6 vs. 3.3, P = 0.036), and higher overall mortality (23.8% vs. 0%, P = 0.048). Patients with TADI >28 received stent grafting at significantly shorter median time intervals from injury identification (median 4 hrs vs. 14 hrs, P = 0.001). Overall causes of mortality were aortic hemorrhage related (n = 3, 60%) and TBI (n = 2, 40%).
      Conclusions: This simple-to-calculate index is independently correlated with mortality and urgency of stent grafting in blunt trauma patients with similar ISS. Patients with TADI scores >28 were more likely to undergo urgent stent grafting, thereby suggesting a trend in practice patterns with higher scores representing injuries that should be considered for expedited operative management. The TADI score should be validated in a larger sample of blunt trauma patients as an injury prioritization tool in the multisystem injured patient.
      (Copyright © 2024 Elsevier Inc. All rights reserved.)
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    • Grant Information:
      KL2 TR001448 United States TR NCATS NIH HHS
    • Publication Date:
      Date Created: 20241016 Date Completed: 20241211 Latest Revision: 20241213
    • Publication Date:
      20241213
    • Accession Number:
      PMC11634631
    • Accession Number:
      10.1016/j.avsg.2024.08.031
    • Accession Number:
      39413997