title: Aortic injuries in crush trauma patients: different mechanism, different management.
abstract: BACKGROUND
  The objective of this study is to report the clinical and radiological characteristics and early and long-term survival of a series of acute traumatic aortic injuries (ATAI) in crush trauma patients, and to compare such data with our last 30 years experience managing ATAI in deceleration non-crush trauma patients.
  
  
  METHODS
  From January 1980 to December 2010, 5 consecutive ATAI in crush trauma and 69 in non-crush trauma patients were admitted at our institution. ISS, RTS and TRISS scores were similar in both groups.
  
  
  RESULTS
  Overall in-hospital mortality was 24.3%. There was no in-hospital mortality in crush patients and 26.1% in non-crush patients (p=0.32). All aortic-related complications occurred in non-crush patients. Median follow-up was 129 months (range 3-350 months). Non-crush group survival was 76.8% at 1 year, 73.6% at 5 years, and 71.2%% at 10 years. There was no mortality during follow-up in the crush group. Mean (SD) peak creatine phosphokinase was significantly higher in crush group than in non-crush group: 7598 (3690) IU/L vs. 3645 (2506) IU/L; p=0.041. Incidence of acute renal injury was higher in crush trauma patients (100% vs. 36.2%; p=0.018). Low-severity injuries were more common in crush trauma patients (100% in crush patients vs. 43.5% in non-crush patients, p=0.04).
  
  
  CONCLUSIONS
  Aortic injuries in crush thoracic trauma patients seem to present in a different clinical scenario from aortic injuries in high-speed thoracic trauma thus requiring distinct considerations. When planning the initial management of aortic injuries in crush trauma, the increased risk of rhabdomiolysis and subsequent acute renal failure, as well as a tendency to develop lower-risk aortic wall injuries, must be considered.
authors: Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, Spain. vxmr@yahoo.es
authors: Victor X
authors: VX
authors: Mosquera
authors: Milagros
authors: M
authors: Marini
authors: Javier
authors: J
authors: Muñiz
authors: José M
authors: JM
authors: Lopez-Perez
authors: Daniel
authors: D
authors: Gulías
authors: José J
authors: JJ
authors: Cuenca
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery; D003402:Creatine Kinase / Q000097:blood*; D003444:Crush Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D016208:Databases, Factual; D042241:Early Diagnosis; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000175:diagnosis* / Q000201:enzymology / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications*
chemical_list: D003402:Creatine Kinase