Contemporary analysis of thoracic aortic injury: importance of screening based on crash characteristics.
BACKGROUND
To use motor vehicle crash (MVC) characteristics to determine risk of thoracic aortic injury (TAI) and provide updated mortality data.


METHODS
Vehicle crash variables and patient medical data from 64,245 MVC occupants (1988-2002) were obtained from the National Automotive Sampling System. Descriptive and logistic regression analyses were used to determine the relationship of crash and occupant characteristics to TAI.


RESULTS
Seven hundred ninety occupants (1.2%) had TAI. Overall mortality with TAI was 92%. Prehospital mortality was 63%. Patients taken to a trauma center had significantly lower mortality (75%) than did patients taken to a non-trauma center (90%) (p = 0.006). Risk of TAI was highest with a near-side crash impact. Risk of TAI increased with increasing change in velocity and increasing mass of the striking vehicle. Seat belts were protective not only for all occupants in frontal crashes, but also for drivers and front passengers in a near side lateral impact, whereas airbags were protective only in frontal crashes. No specific injuries reliably predicted TAI with sufficient sensitivity and specificity to be clinically useful.


CONCLUSIONS
TAI remains a highly lethal injury. Prehospital mortality in this series is lower than in most previous reports, and survival is higher at trauma centers versus non-trauma centers. Associated injuries are poor predictors of TAI. Screening for TAI should include increased emphasis on crash and vehicle occupant characteristics, especially high-velocity MVC, near-side impact, and lack of seat belt use.
Michetti
Christopher P
CP
Inova Regional Trauma Center and the Honda Inova Fairfax Hospital CIREN Center, Inova Fairfax Hospital, Falls Church, Virginia 22042, USA. christopher.michetti@inova.com
Hanna
Refaat
R
Crandall
Jeff R
JR
Fakhry
Samir M
SM
D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D017278:Air Bags; D001013:Aorta, Thoracic / Q000293:injuries*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology; D012622:Seat Belts / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000453:epidemiology; D014218:Triage; D014949:Wounds, Nonpenetrating / Q000401:mortality*