Abstract
Purpose
Early identification of blunt thoracic aortic injury is vital for preventing subsequent aortic rupture. However, risk factors for blunt thoracic aortic injury remain unclear, and a prediction rule remains to be established. We developed and internally validated a new nomogram-based screening model that allows clinicians to quantify blunt thoracic aortic injury risk.
Methods
Adult patients (age ≥ 18 years) with blunt injury were selected from a nationwide Japanese database (January 2004–May 2019). Patients were randomly divided into training and test cohorts. A new nomogram-based blunt thoracic aortic injury-screening model was constructed using multivariate logistic regression analysis to quantify the association of potential predictive factors with blunt thoracic aortic injury in the training cohort.
Results
Overall, 305,141 patients (training cohort, n = 152,570; test cohort, n = 152,571) were eligible for analysis. Median patient age was 65 years, and 60.9% were men. Multivariate analysis in the training cohort revealed that 13 factors (positive association: age ≥ 55 years, male sex, high-energy impact, hypotension on hospital arrival, Glasgow Coma Scale score < 9 on hospital arrival, diaphragmatic injuries, hepatic injuries, pulmonary injuries, cardiac injuries, renal injuries, sternum fractures, multiple rib fractures, and pelvic fractures) were significantly associated with blunt thoracic aortic injury and included in the screening model. In the test cohort, the new screening model had an area under the curve of 0.87.
Conclusions
Our novel nomogram-based screening model aids in the quantitative assessment of blunt thoracic aortic injury risk. This model may improve tailored decision-making for each patient.
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Data availability
The authors are not authorized to distribute the dataset. Please contact the Japanese Association for the Surgery of Trauma (Trauma Registry Committee) and the Japanese Association for Acute Medicine (Committee for Clinical Care Evaluations) for data requests.
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KS: conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. HM, TI, KS, and YH: contributed to the analysis and interpretation of data, and revised the manuscript critically for important intellectual content. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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The authors have no competing interests to declare that are relevant to the content of this article.
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This study was approved by the Institutional Review Board (approval number: 02–111). The need for informed consent was waived because the data were anonymized before analysis, and patients’ personal information were protected.
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Shibahashi, K., Matsunaga, H., Ishida, T. et al. A new screening model for quantitative risk assessment of blunt thoracic aortic injury. Eur J Trauma Emerg Surg 48, 4607–4614 (2022). https://doi.org/10.1007/s00068-022-01925-y
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DOI: https://doi.org/10.1007/s00068-022-01925-y