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Mid-term Outcome of Blunt Aortic Injury: A Multi-centered Study
Douglas Stockton, M.D.1, Bahaa Succar1, Benjamin Brooke, M.D.2, Sharon Kiang, M.D.3, Leigh Ann O'banion, M.D.4, Heather Matheny, M.D.4, Nina Bowens, M.D.5, Wei zhou, M.D.1.
1The University of Arizona, Tucson, AZ, USA, 2The University of Utah, Salt Lake City, UT, USA, 3Loma Linda University, Loma Linda, CA, USA, 4The University of California San Francisco, Fresno, CA, USA, 5The University of California Los Angeles, Los Angeles, CA, USA.

OBJECTIVES:Blunt aortic injury (BAI) is among the leading causes of death in trauma patients. Current guidelines recommend surgery for aortic injuries grade III and IV. However, mid-term outcome data is lacking for characteristics suggestive of improved survival, and standardized recommendations for intervention are weak. We sought to evaluate the mid-term outcome and characteristics associated with survival in patients with BAI. METHODS: This was a multi-centered retrospective cohort study of BAI from 2010 to 2020. Patients were identified from 5 tertiary level 1 trauma centers across the US, and data abstraction was performed using institutional trauma or administrative database. The primary endpoint was 2-year survival. The cohort was divided into “Surgical” vs “Non-surgical” treatment groups. Independent samples t-test, and Chi square test were used to compare patient characteristics. Kaplan-Meier survival curves were generated, and log-rank test was used to assess differences in survival based on management. Multivariable Cox proportional hazard regression was performed to identify variables associated with survival. RESULTS:A total of 235 patients were identified with a mean ISS of 37. There were 48 patients (20%) deceased before any intervention, and 19(8%) dead within 30 days. 119 patients received surgical intervention and 68 underwent non-surgical treatment. The surgical group had a higher rate of hypotension on arrival (36% vs. 18%, P<0.01), higher ISS (35 ±13 vs 28 ±11, p<0.001), and higher aortic injury grade(P<0.01). The majority (89%) of surgical patients were intervened within 24 hours of injury, and 91% had aortic injury grade of III/IV compared to 15% in the non-surgical group. Endovascular therapy was the most common surgical approach (88%). The 2-year cumulative survival for the entire cohort was 62%, and similar between surgical and non-surgical patients (p=0.95). Age<65 years (aHR [95% CI]: 0.38 [0.22-0.66], p<0.001) and lower ISS (aHR [95% CI]: 0.96 [0.95-0.98], p<0.001) were independent predictors of 2-year survival after adjusting for confounders. CONCLUSIONS:This study highlights high mortality rate of BAI, particularly in older patients with high ISS, and supports aggressive endovascular intervention for aortic injury grade III and IV. Guideline-adherence approach yields similar mid-term survival between surgery and medical interventions despite unfavorable baseline characteristics in the surgical group.


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