title: A contemporary rural trauma center experience in blunt traumatic aortic injury.
abstract: BACKGROUND
  Traumatic aortic injury (TAI) is a rare yet highly lethal injury associated with blunt force deceleration injury. The adoption of thoracic endovascular aortic repair (TEVAR) has become a safer option than traditional open repair. The purpose of this study is to review a rural trauma center experience with TAI.
  
  
  METHODS
  A retrospective analysis was performed, reviewing all patients who presented with TAI between 2000 and 2009. Clinical, anatomical, and procedural variables of all cases were systematically reviewed. Clinical endpoints included mortality, and aortic-related mortality, and hospital length of stay. The study population was stratified by those that underwent surgical repair (SR) and those managed medically (MM).
  
  
  RESULTS
  Fifty-six patients presented with blunt TAI; 35 patients (62.5%) were surgically repaired (22 open, 13 TEVAR), while 21 (37.5%) were MM. The only difference in comorbidities was a higher rate of coronary artery disease in MM. Mean hospital arrival time (SR, 188.6 ± 30.3 minutes, MM, 253 ± 65.3 minutes), aortic injury grade (SR, 2.7 ± 0.1; MM, 2.3 ± 0.2), and injury severity score were not significantly different between the groups. Head Abbreviated Injury Score (AIS) was worse in the MM group, while chest AIS was worse in the SR group (P < .05). There were nine (42.9%) deaths in the MM group, while there were only two (5.7%) in the SR group (P < .001). There was no significant difference in aortic-related mortality. Mean follow-up time was not statistically different.
  
  
  CONCLUSIONS
  These data provide a group of stable patients to examine the management of TAI in the endovascular era. The low aortic-related mortality in the MM group demonstrates that there is time for a thorough evaluation in patients sustaining TAI who arrive without hemodynamic instability.
authors.affiliation: Department of Surgery, East Carolina University, Greenville, NC, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Durham
authors.forename: Michael M
authors.initials: MM
authors.lastname: McNally
authors.forename: Frank M
authors.initials: FM
authors.lastname: Parker
authors.forename: William M
authors.initials: WM
authors.lastname: Bogey
authors.forename: Charles S
authors.initials: CS
authors.lastname: Powell
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Goettler
authors.forename: Michael F
authors.initials: MF
authors.lastname: Rotondo
authors.forename: Michael C
authors.initials: MC
authors.lastname: Stoner
mesh_terms: D000328:Adult; D001011:Aorta / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006439:Hemodynamics; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*