title: Vancouver simplified grading system with computed tomographic angiography for blunt aortic injury.
abstract: OBJECTIVE
  Delineation of blunt aortic injury by computed tomographic angiography guides management of this potentially fatal injury. Two existing grading systems are problematic to apply and not linked to outcomes. A simplified computed tomographic angiography-based grading system, linked to clinical outcomes, was developed, and feasibility and reliability were evaluated.
  
  
  METHODS
  Retrospective review was performed of all blunt aortic injury cases presenting to a single provincial quaternary referral center designated for blunt aortic injury management between 2001 and 2009. Management, associated injuries, hospital survival, and cause of death were determined. Initial computed tomographic angiography was reviewed, and injuries were graded according to the new Vancouver simplified grading system by 2 study authors. Three additional trauma radiologists then graded the aortic injuries with the 2 existing systems and the simplified system. Interrater reliability was determined.
  
  
  RESULTS
  Forty-eight patients were identified. Two had minimal aortic injury (grade I), 7 had an intimal flap larger than 1 cm (grade II), 32 had traumatic pseudoaneurysm (grade III), 6 had active contrast extravasation (grade IV), and 1 could not be rated. Survivals were 100%, 90%, and 33% for grades I and II, III, and IV, respectively. Of grade III injuries, 14% were medically managed, 68% repaired endovascularly, and 18% repaired with open surgery. Interrater correlation was best with the simplified score, with only 0.5% of cases unable to be classified.
  
  
  CONCLUSIONS
  The Vancouver simplified blunt aortic injury grading system is easy to use and correlates with clinical outcomes. Prospective external validation is required.
authors: Division of Cardiothoracic Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada. yoanlamarche@gmail.com
authors: Yoan
authors: Y
authors: Lamarche
authors: Ferco H
authors: FH
authors: Berger
authors: Savvas
authors: S
authors: Nicolaou
authors: Ana-Maria
authors: AM
authors: Bilawich
authors: Luck
authors: L
authors: Louis
authors: Joao Rodrigues
authors: JR
authors: Inacio
authors: Michael T
authors: MT
authors: Janusz
authors: David
authors: D
authors: Evans
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D001011:Aorta / Q000293:injuries*; D015897:Comorbidity; D005260:Female; D006335:Heart Injuries / Q000145:classification* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009104:Multiple Trauma / Q000453:epidemiology; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000145:classification* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D055815:Young Adult