title: Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture.
abstract: OBJECTIVE
  There were two aims of this study. The first was to evaluate the application of helical computed tomography of the thorax (HCTT) for the diagnosis of blunt aortic injury (BAI). The second was to evaluate the efficacy of beta-blockers with or without nitroprusside in preventing aortic rupture.
  
  
  BACKGROUND
  Aortography has been the standard for diagnosing BAI for the past 4 decades. Conventional chest CT has not proven to be of significant value. Helical CT scanning is faster and has higher resolution than conventional CT. Retrospective studies have suggested the efficacy of antihypertensives in preventing aortic rupture.
  
  
  METHODS
  A prospective study comparing HCTT to aortography in the diagnosis of BAI was performed. A protocol of beta-blockers with or without nitroprusside was also examined for efficacy in preventing rupture before aortic repair and in allowing delayed repair in patients with significant associated injuries.
  
  
  RESULTS
  Over a period of 4 years, 494 patients were studied. BAI was diagnosed in 71 patients. Sensitivity was 100% for HCTT versus 92% for aortography. Specificity was 83% for HCTT versus 99% for aortography. Accuracy was 86% for HCTT versus 97% for aortography. Positive predictive value was 50% for HCTT versus 97% for aortography. Negative predictive value was 100% for HCTT versus 97% for aortography. No patient had spontaneous rupture in this study.
  
  
  CONCLUSIONS
  HCTT is sensitive for diagnosing intimal injuries and pseudoaneurysms. Patients without direct HCTT evidence of BAI require no further evaluation. Aortography can be reserved for indeterminate HCTT scans. Early diagnosis with HCTT and presumptive treatment with the antihypertensive regimen eliminated in-hospital aortic rupture.
authors.affiliation: Department of Surgery, University of Tennessee, Memphis 38163, USA.
authors.forename: T C
authors.initials: TC
authors.lastname: Fabian
authors.forename: K A
authors.initials: KA
authors.lastname: Davis
authors.forename: M L
authors.initials: ML
authors.lastname: Gavant
authors.forename: M A
authors.initials: MA
authors.lastname: Croce
authors.forename: S M
authors.initials: SM
authors.lastname: Melton
authors.forename: J H
authors.initials: JH
authors.lastname: Patton
authors.forename: C K
authors.initials: CK
authors.lastname: Haan
authors.forename: D S
authors.initials: DS
authors.lastname: Weiman
authors.forename: J W
authors.initials: JW
authors.lastname: Pate
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001011:Aorta / Q000293:injuries*; D001019:Aortic Rupture / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D001027:Aortography; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007741:Labetalol / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000627:therapeutic use; D011412:Propanolamines / Q000627:therapeutic use; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D011412:Propanolamines; D009599:Nitroprusside; C036604:esmolol; D007741:Labetalol