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Limited influence of blunt aortic injuries on the outcome of polytraumatized patients: a matched pair analysis

Archives of Orthopaedic and Trauma Surgery volume 138, pages 211–218 (2018)Cite this article

Abstract

Introduction

Traumatic lesions of great vessels such as the aorta are life-threatening injuries. There is limited evidence about the influence of traumatic aortic injuries in multiple trauma patients in particular with regard to posttraumatic complications. The aim of this study was to evaluate the influence of blunt thoracic aortic injuries in multiple trauma patients compared to a multiple trauma cohort without this specific injury. In addition, the safety of Thoracic Endovascular Aortic Repair (TEVAR) in multiple trauma patients was analyzed.

Materials and methods

A retrospective study was performed. We included all multiple trauma patients (ISS ≥ 16, age > 14 years) between 2005 and 2014 with (group BTAI) and without (group nBTAI) blunt traumatic aortic injuries who were treated at our level-1 trauma center. Demographic as well as clinical parameters were analyzed including injury pattern, mechanism of injury, posttraumatic complications such as ARDS, multiple organ dysfunction syndrome (MODS) and others. A matched pair analysis was performed by propensity score matching.

Results

In total, 721 patients were enrolled (group BTAI: n = 45; nBTAI: n = 676). In the initial study population, surgical intervention was done in n = 32 (71.1%) patients (TEVAR: n = 25; 78.1%), there was an increased AISChest and overall injury severity in group BTAI with associated significantly more posttraumatic complications in group BTAI. The matched pair analysis consisted of 42 patients per group. Beside an increased ventilation time, no significant differences were evident after the matching process. There was a trend to increased risk for SIRS using binary logistic regression analysis.

Conclusions

Multiple trauma patients with blunt thoracic aortic injuries who are treated at a level-1 trauma center show a comparable outcome matched to their counterparts without aortic injuries. Our study confirms that using TEVAR in polytraumatized patients is a safe procedure. In all patients treated with TEVAR, there were no procedure-related complications, especially no neurological deficit.

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Affiliations

  1. Trauma Department, Hannover Medical School, Hannover, Germany

    A. Omar, C. Macke, M. Winkelmann, P. Mommsen, C. Schröter, C. Krettek & Christian Zeckey

  2. Department of General-, Trauma- and Reconstructive Surgery, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 80377, Munich, Germany

    Christian Zeckey

  3. Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany

    E. Beckmann

  4. Trauma Department, Wolfsburg Hospital, Wolfsburg, Germany

    C. Schröter

Authors
  1. A. Omar
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  2. C. Macke
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  3. M. Winkelmann
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  4. E. Beckmann
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  5. P. Mommsen
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  6. C. Schröter
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  7. C. Krettek
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  8. Christian Zeckey
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Contributions

AO: Data management, Analysis and interpretation of data, writing of the manuscript, revision of the manuscript; CM: Study design, Analysis and interpretation of data, writing of the manuscript; EB: Analysis and interpretation of the data, manuscript revision; CS: Analysis of data, Revision of the manuscript; MW: Analysis and interpretation of data, revision of the manuscript; PM: Analysis and interpretation of data, revision of the manuscript; CK: Study design, interpretation of the data, revision of the manuscript; CZ: Study design, analysis and interpretation of the data, writing and revision of the manuscript.

Corresponding author

Correspondence to Christian Zeckey.

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Conflict of interest

There are no commercial or similar relationships of the authors to products or companies related to the manuscript. No funding was necessary for this article. The article is not under consideration for publication in another journal, website or textbook. There are no competing interests.

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Omar, A., Macke, C., Winkelmann, M. et al. Limited influence of blunt aortic injuries on the outcome of polytraumatized patients: a matched pair analysis. Arch Orthop Trauma Surg 138, 211–218 (2018). https://doi.org/10.1007/s00402-017-2842-4

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  • DOI: https://doi.org/10.1007/s00402-017-2842-4

Keywords

  • Trauma
  • Major trauma management