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Deceleration thoracic aortic ruptures in trauma center level I areas: a 6-year retrospective study

  • Jan TrlicaEmail author
  • Štěpánka Kučerová
  • Eva Kočová
  • Jaromír Kočí
  • Petr Habal
  • Jan Raupach
  • Igor Guňka
  • Lukáš Nechvátal
  • Jiří Páral
  • Jan Šimek
  • Karel Šmejkal
  • Martin Frank
  • Tomáš Dědek
Original Article
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Abstract

Objectives

This retrospective study aimed to analyze the trend of mortality due to thoracic aortic ruptures caused by deceleration injuries that occurred within the catchment area of Hradec Kralove University Hospital.

Materials and methods

The study sample comprised 175 patients who had sustained thoracic aortic ruptures caused by deceleration injuries and were transported to Hradec Kralove University Hospital in 2009–2014. The small proportion of patients enrolled in this retrospective study were diagnosed and treated at the emergency department (ED). However, the overwhelming majority of the sample comprised of patients who died at the accident scene and later underwent an autopsy at the Institute of Forensic Medicine in our hospital.

Results

Of 175 patients, 150 underwent an autopsy. Of these, 139 individuals (79%) died at the incident scene, and 11 (6%) were transported to the ED and later died of their injuries. A total of 36 patients were admitted to the hospital; 29 were admitted primary (11 later died), and 7 were transferred. No deaths occurred in the group of secondary admissions. Thus, 31% of all patients hospitalized died following transport to the hospital. Of 175 patients, 15% (or 69% of all hospitalized patients) survived their injuries. Among patients who died as a result of thoracic aortic injury, no unexpected deaths were recorded (i.e., no deaths among patients with survival probability more than 50% = PS > 0.5).

Conclusion

Our results suggested that the lethality of thoracic aortic injuries might be minimized by transporting triage-positive patients directly to trauma centers. Accurate diagnoses and treatments were supported by admission chest X-rays, a massive transfusion protocol, and particularly, CT angiography, which is not routinely included in primary surveys. An additional prognostic parameter was clinical collaboration between an experienced trauma surgeon, an interventional radiologist, and a vascular or thoracic surgeon.

Keywords

Thoracic aorta Deceleration injury Mortality Stent graft Surgery 

Notes

Funding

This work was supported by: The Ministry of Health of the Czech Republic—Conceptual Development of Research Organization (FNHK, 00179906). The Ministry of Defense of the Czech Republic—A long-term organization development plan 1011.

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.

References

  1. 1.
    Demetriades D. Blunt thoracic aortic injuries: crossing the rubicon. J Am Coll Surg. 2012;214(3):247–59.CrossRefGoogle Scholar
  2. 2.
    Třeška V, Šlauf F, Čertík B, Šulc R, Čechura M, Moláček J, et al. Traumatická ruptura hrudní aorty. Rozhl V Chir Měsíč Českoslov Chir Spol. 2012;91(10):535–8.Google Scholar
  3. 3.
    Teixeira PG, Inaba K, Barmparas G. Blunt thoracic aortic injuries: an autopsy study. J Vasc Surg J Vasc Surg. 2011;54(2):581.CrossRefGoogle Scholar
  4. 4.
    Hiller RJ, Mikocka-Walus AA, Cameron PA. Aortic transection: demographics, treatment and outcomes in Victoria, Australia. Emerg Med J Emerg Med J. 2010;27(5):368.CrossRefGoogle Scholar
  5. 5.
    Kerut EK, Kelley G, Falco VC, Ovella T, Diethelm L, Helmcke F. Traumatic deceleration injury of the thoracic aorta. Echocardiogr Mt KISCO. 2005;22(8):697–704.CrossRefGoogle Scholar
  6. 6.
    Nikolic S. Forensic expertise of thoracic aorta, heart and pericardial injuries in caroccupant fatalities. Srp Arh Celok Lek Srp Arh Za Celok Lek. 2009;137(11–12):627–31.CrossRefGoogle Scholar
  7. 7.
    McKnigh JT, Meyer JA, Neville JF. Nonpenetrating traumatic rupture of the thoracic aorta. Ann Surg Ann Surg. 1964;160(6):1069–72.CrossRefGoogle Scholar
  8. 8.
    Richens D. Rupture of the aorta following road traffic accidents in the United Kingdom 1992–1999: the results of a cooperative crash injury study. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio Thorac Surg. 2003;23(2):143–8.CrossRefGoogle Scholar
  9. 9.
    Hazuková R, Hottmar P, Lonský V, Safr M, Kunes P. Četnost výskytu úrazové ruptury aorty u posádek automobilů při čelním střetu se statickou či dynamickou protijedoucí překážkou. Soud Lékarství Cas Sekce Soud Lékarstvi Cs Lékarské. Spolecnosti J Ev Purkyne. 2002;47(4):59–63.Google Scholar
  10. 10.
    Raupach J, Ferko A, Lojik M, Krajina A, Harrer J, Dominik J. Endovascular treatment of acute and chronic thoracic aortic injury. Cardiovasc Intervent Radiol. 2007;30(6):1117–23.CrossRefGoogle Scholar
  11. 11.
    US Department of Health and Human Services (HHS). Centers for Disease Control and prevention. Morbidity and Mortality Weekly Report: recommendations of the National expert panel on field triage. 2011;61:1.Google Scholar
  12. 12.
    Marnocha KE, Maglinte D, Woods J, Peterson PC, Dolan PA, Nigh A, et al. Blunt chest trauma and suspected aortic rupture: reliability of chest radiograph findings. YMEM Ann Emerg Med. 1985;14(7):644–9.CrossRefGoogle Scholar
  13. 13.
    Marsh DG, Sturm JT. Traumatic aortic rupture: roentgenographic indications for angiography. Ann Thorac Surg Ann Thorac Surg. 1976;21(4):337–40.CrossRefGoogle Scholar
  14. 14.
    Greenspan L, Greig H, McLellan BA. Abbreviated Injury Scale and Injury Severity Score: a scoring chart. J Trauma. 1985;25(1):60–4CrossRefGoogle Scholar
  15. 15.
  16. 16.
    Franzen D, Genoni M. Analysis of risk factors for death after blunt traumatic rupture of the thoracic aorta. Emerg Med J EMJ. 2015;32(2):124–9.CrossRefGoogle Scholar
  17. 17.
    Belwadi A, Siegel JH, Singh A, Smith JA, Yang KH, King AI. Finite element aortic injury reconstruction of near side lateral impacts using real world crash data. J Biomech Eng 2012;134(1):011006CrossRefGoogle Scholar
  18. 18.
    Marnocha KE, Maglinte DD, Woods J, Goodman M, Peterson P. Mediastinalwidth/chest-width ratio in blunt chest trauma: a reappraisal. AJR Am J Roentgenol. 1984;142(2):275–7.CrossRefGoogle Scholar
  19. 19.
    Woodring JH, Dillon ML. Radiographic manifestations of mediastinal hemorrhage from blunt chest trauma. Ann Thorac Surg. 1984;37(2):171–8.CrossRefGoogle Scholar
  20. 20.
    Mirvis SE, Bidwell JK, Buddemeyer EU, Diaconis JN, Pais SO, Whitley JE, et al. Value of chest radiography in excluding traumatic aortic rupture. Radiology. 1987;163(2):487–93.CrossRefGoogle Scholar
  21. 21.
    Simeone A, Freitas M, Frankel HL. Management options in blunt aortic injury: a case series and literature review. Am Surg. 2006;72(1):25–30.Google Scholar
  22. 22.
    Fattori R, Russo V, Lovato L, Di Bartolomeo R. Optimal management of traumatic aortic injury. J Vasc Surg J Vasc Surg. 2009;49(1):275.CrossRefGoogle Scholar
  23. 23.
    de Mestral C, Dueck A, Sharma SS, Haas B, Gomez D, Hsiao M, et al. Evolution of the incidence, management, and mortality of blunt thoracic aortic injury: a population-based analysis. J Am Coll Surg. 2013;216(6):1110–5.CrossRefGoogle Scholar
  24. 24.
    Cook J, Salerno C, Krishnadasan B, Nicholls S, Meissner M, Karmy-Jones R. The effect of changing presentation and management on the outcome of blunt rupture of the thoracic aorta. J Thorac Cardiovasc Surg. 2006;131(3):594–600.CrossRefGoogle Scholar
  25. 25.
    Smith RS, Chang FC. Traumatic rupture of the aorta: still a lethal injury. Am J Surg. 1986;152(6):660–3.CrossRefGoogle Scholar
  26. 26.
    Reed AB, Thompson JK, Crafton CJ, Delvecchio C, Giglia JS. Timing of endovascular repair of blunt traumatic thoracic aortic transections. J Vasc Surg. 2006;43(4):684–8.CrossRefGoogle Scholar
  27. 27.
    Xenos ES, Minion DJ, Davenport DL, Hamdallah O, Abedi NN, Sorial EE, et al. Endovascular versus open repair for descending thoracic aortic rupture: institutional experience and meta-analysis. Eur J Cardio Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2009;35(2):282–6.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jan Trlica
    • 1
    • 6
    Email author return OK on get
  • Štěpánka Kučerová
    • 2
    • 6
  • Eva Kočová
    • 4
    • 6
  • Jaromír Kočí
    • 1
    • 6
  • Petr Habal
    • 3
    • 6
  • Jan Raupach
    • 4
    • 6
  • Igor Guňka
    • 1
    • 6
  • Lukáš Nechvátal
    • 1
    • 6
  • Jiří Páral
    • 1
    • 5
    • 6
  • Jan Šimek
    • 1
    • 5
  • Karel Šmejkal
    • 1
    • 5
  • Martin Frank
    • 1
    • 6
  • Tomáš Dědek
    • 1
    • 6
  1. 1.Department of SurgeryUniversity Hospital in Hradec KraloveHradec KrálovéCzech Republic
  2. 2.Institute of Forensic MedicineUniversity Hospital in Hradec KraloveHradec KrálovéCzech Republic
  3. 3.Department of Cardiac SurgeryUniversity Hospital in Hradec KraloveHradec KrálovéCzech Republic
  4. 4.Department of RadiologyUniversity Hospital in Hradec KraloveHradec KrálovéCzech Republic
  5. 5.Faculty of Military Health SciencesUniversity of DefenseHradec KrálovéCzech Republic
  6. 6.Faculty of Medicine in Hradec KraloveCharles University in PragueHradec KrálovéCzech Republic

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