Prospective study of blunt aortic injury

Multicenter trial of the American Association for the Surgery of Trauma

Timothy C. Fabian, J. David Richardson, Martin A. Croce, J. Stanley Smith, George Rodman, Paul A. Kearney, William Flynn, Arthur L. Ney, John B. Cone, Fred A. Luchette, David H. Wisner, Donald J. Scholten, Bonnie L. Beaver, Alasdair K. Conn, Robert Coscia, David B. Hoyt, John A. Morris, J. Duncan Harviel, Andrew B. Peitzman, Raymond P. Bynoe & 31 others Daniel L. Diamond, Matthew Wall, Jonathan D. Gates, Juan A. Asensio, Mary C. McCarthy, Murray J. Girotti, Mary VanWijngaarden, Thomas H. Cogbill, Marc A. Levison, Charles Aprahamian, John E. Sutton, C. F. Allen, Erwin F. Hirsch, Kimberly Nagy, Ben L. Bachulis, Charles R. Bales, Marc J. Shapiro, Michael H. Metzler, Vincent Conti, Christopher C. Baker, Michael P. Bannon, M. Gage Ochsner, Michael H. Thomason, Jonathan R. Hiatt, Keith O'Malley, Farouck N. Obeid, Perry Gray, Paul E. Bankey, M. Margaret Knudson, Donna Lynn Dyess, Blaine L. Enderson

Research output: Contribution to journalArticle

589 Citations (Scopus)

Abstract

Background: Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. Methods: This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi- institutional Trial Committee of the American Association for the Surgery of Trauma. Results: There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of ≤30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. Conclusions: Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.

Original languageEnglish (US)
Pages (from-to)374-382
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume42
Issue number3
DOIs
StatePublished - Mar 1997

Fingerprint

Nonpenetrating Wounds
Paraplegia
Multicenter Studies
Prospective Studies
Wounds and Injuries
Aortography
Aortic Rupture
Automobiles
Mortality
Trauma Centers
Transesophageal Echocardiography
Thoracotomy
North America
Rupture
Cause of Death
Thorax
Perfusion
Logistic Models
Tomography
Regression Analysis

Keywords

  • Blunt aortic injury
  • management

ASJC Scopus subject areas

  • Surgery

Cite this

Prospective study of blunt aortic injury : Multicenter trial of the American Association for the Surgery of Trauma. / Fabian, Timothy C.; Richardson, J. David; Croce, Martin A.; Smith, J. Stanley; Rodman, George; Kearney, Paul A.; Flynn, William; Ney, Arthur L.; Cone, John B.; Luchette, Fred A.; Wisner, David H.; Scholten, Donald J.; Beaver, Bonnie L.; Conn, Alasdair K.; Coscia, Robert; Hoyt, David B.; Morris, John A.; Harviel, J. Duncan; Peitzman, Andrew B.; Bynoe, Raymond P.; Diamond, Daniel L.; Wall, Matthew; Gates, Jonathan D.; Asensio, Juan A.; McCarthy, Mary C.; Girotti, Murray J.; VanWijngaarden, Mary; Cogbill, Thomas H.; Levison, Marc A.; Aprahamian, Charles; Sutton, John E.; Allen, C. F.; Hirsch, Erwin F.; Nagy, Kimberly; Bachulis, Ben L.; Bales, Charles R.; Shapiro, Marc J.; Metzler, Michael H.; Conti, Vincent; Baker, Christopher C.; Bannon, Michael P.; Ochsner, M. Gage; Thomason, Michael H.; Hiatt, Jonathan R.; O'Malley, Keith; Obeid, Farouck N.; Gray, Perry; Bankey, Paul E.; Knudson, M. Margaret; Dyess, Donna Lynn; Enderson, Blaine L.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 42, No. 3, 03.1997, p. 374-382.

Research output: Contribution to journalArticle

Fabian, TC, Richardson, JD, Croce, MA, Smith, JS, Rodman, G, Kearney, PA, Flynn, W, Ney, AL, Cone, JB, Luchette, FA, Wisner, DH, Scholten, DJ, Beaver, BL, Conn, AK, Coscia, R, Hoyt, DB, Morris, JA, Harviel, JD, Peitzman, AB, Bynoe, RP, Diamond, DL, Wall, M, Gates, JD, Asensio, JA, McCarthy, MC, Girotti, MJ, VanWijngaarden, M, Cogbill, TH, Levison, MA, Aprahamian, C, Sutton, JE, Allen, CF, Hirsch, EF, Nagy, K, Bachulis, BL, Bales, CR, Shapiro, MJ, Metzler, MH, Conti, V, Baker, CC, Bannon, MP, Ochsner, MG, Thomason, MH, Hiatt, JR, O'Malley, K, Obeid, FN, Gray, P, Bankey, PE, Knudson, MM, Dyess, DL & Enderson, BL 1997, 'Prospective study of blunt aortic injury: Multicenter trial of the American Association for the Surgery of Trauma', Journal of Trauma - Injury, Infection and Critical Care, vol. 42, no. 3, pp. 374-382. https://doi.org/10.1097/00005373-199703000-00003
Fabian, Timothy C. ; Richardson, J. David ; Croce, Martin A. ; Smith, J. Stanley ; Rodman, George ; Kearney, Paul A. ; Flynn, William ; Ney, Arthur L. ; Cone, John B. ; Luchette, Fred A. ; Wisner, David H. ; Scholten, Donald J. ; Beaver, Bonnie L. ; Conn, Alasdair K. ; Coscia, Robert ; Hoyt, David B. ; Morris, John A. ; Harviel, J. Duncan ; Peitzman, Andrew B. ; Bynoe, Raymond P. ; Diamond, Daniel L. ; Wall, Matthew ; Gates, Jonathan D. ; Asensio, Juan A. ; McCarthy, Mary C. ; Girotti, Murray J. ; VanWijngaarden, Mary ; Cogbill, Thomas H. ; Levison, Marc A. ; Aprahamian, Charles ; Sutton, John E. ; Allen, C. F. ; Hirsch, Erwin F. ; Nagy, Kimberly ; Bachulis, Ben L. ; Bales, Charles R. ; Shapiro, Marc J. ; Metzler, Michael H. ; Conti, Vincent ; Baker, Christopher C. ; Bannon, Michael P. ; Ochsner, M. Gage ; Thomason, Michael H. ; Hiatt, Jonathan R. ; O'Malley, Keith ; Obeid, Farouck N. ; Gray, Perry ; Bankey, Paul E. ; Knudson, M. Margaret ; Dyess, Donna Lynn ; Enderson, Blaine L. / Prospective study of blunt aortic injury : Multicenter trial of the American Association for the Surgery of Trauma. In: Journal of Trauma - Injury, Infection and Critical Care. 1997 ; Vol. 42, No. 3. pp. 374-382.
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abstract = "Background: Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. Methods: This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi- institutional Trial Committee of the American Association for the Surgery of Trauma. Results: There were 274 blunt aortic injury cases studied over 2.5 years, of which 81{\%} were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80{\%} diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35{\%}) and bypass techniques in 134 (65{\%}). Overall mortality was 31{\%}, with 63{\%} of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7{\%}. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of ≤30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. Conclusions: Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.",
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T1 - Prospective study of blunt aortic injury

T2 - Multicenter trial of the American Association for the Surgery of Trauma

AU - Fabian, Timothy C.

AU - Richardson, J. David

AU - Croce, Martin A.

AU - Smith, J. Stanley

AU - Rodman, George

AU - Kearney, Paul A.

AU - Flynn, William

AU - Ney, Arthur L.

AU - Cone, John B.

AU - Luchette, Fred A.

AU - Wisner, David H.

AU - Scholten, Donald J.

AU - Beaver, Bonnie L.

AU - Conn, Alasdair K.

AU - Coscia, Robert

AU - Hoyt, David B.

AU - Morris, John A.

AU - Harviel, J. Duncan

AU - Peitzman, Andrew B.

AU - Bynoe, Raymond P.

AU - Diamond, Daniel L.

AU - Wall, Matthew

AU - Gates, Jonathan D.

AU - Asensio, Juan A.

AU - McCarthy, Mary C.

AU - Girotti, Murray J.

AU - VanWijngaarden, Mary

AU - Cogbill, Thomas H.

AU - Levison, Marc A.

AU - Aprahamian, Charles

AU - Sutton, John E.

AU - Allen, C. F.

AU - Hirsch, Erwin F.

AU - Nagy, Kimberly

AU - Bachulis, Ben L.

AU - Bales, Charles R.

AU - Shapiro, Marc J.

AU - Metzler, Michael H.

AU - Conti, Vincent

AU - Baker, Christopher C.

AU - Bannon, Michael P.

AU - Ochsner, M. Gage

AU - Thomason, Michael H.

AU - Hiatt, Jonathan R.

AU - O'Malley, Keith

AU - Obeid, Farouck N.

AU - Gray, Perry

AU - Bankey, Paul E.

AU - Knudson, M. Margaret

AU - Dyess, Donna Lynn

AU - Enderson, Blaine L.

PY - 1997/3

Y1 - 1997/3

N2 - Background: Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. Methods: This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi- institutional Trial Committee of the American Association for the Surgery of Trauma. Results: There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of ≤30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. Conclusions: Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.

AB - Background: Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. Methods: This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi- institutional Trial Committee of the American Association for the Surgery of Trauma. Results: There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of ≤30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. Conclusions: Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.

KW - Blunt aortic injury

KW - management

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