Identification of Unique Characteristics Associated with Traumatic Blunt Aortic Injuries Occurring at Unusual Locations
Michel J Sabra, James W Dennis, Jon Christian Allmon, Joseph H Habib, Shiva Gautam
University of Florida-Jacksonville, Jacksonville, FL
BACKGROUND Blunt traumatic aortic injury (BTAI) is second only to traumatic brain injury as a cause of death in blunt trauma. The usual location of these injuries is just distal to the left subclavian artery, however, injuries can also be found in other locations. The purpose of this study is to identify specific characteristics associated with BTAIs that are found at unusual locations.
METHODS This is a single institution retrospective study using 74 consecutive BTAI patients. Patients were separated into two groups based on whether the injury was located within (usual location) or more than 5 cm (unusual location) from the subclavian artery. A total of 27 factors were compared.
RESULTS Between 2010 and July 2017, we identified 14/74 patients with BTAI (19%) at unusual locations. Females comprised 9/14 (64%) in the unusual location group, whereas females comprised 16/60 (27%) of the usual location group (p<0.012). Thoracic spine fractures occurred in 7/14 (50%) of BTAI at unusual locations, whereas it was associated with only 12/60 (20%) of injuries at the usual location (p<0.038). 11/14 (79%) of the injuries at unusual locations were grade 1 or 2, compared to only 15/60 (25%) of injuries at the usual location. Only 2/14 (14%) BTAI at unusual locations required an endovascular repair as opposed to 39/60 (65%) in the usual group (p<0.001). The mean hospital length of stay in patients with BTAI at the unusual locations was 8.5 days compared to 20.3 days in the usual location group (p<0.004). Mortality occurred in 5/14 (36%) in the unusual location group compared to 5/60 (8%) in the usual location group. No mortalities were related to the BTAI itself in the unusual location group.
CONCLUSION BTAI at unusual locations are associated with several characteristics. They are 1) more frequently associated with thoracic spine injuries, 2) more common in females, 3) tend to be lower grade, 4) less likely to require intervention, and 5) appear to have a higher mortality due to other traumatic injuries.
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