title: Evolution of the incidence, management, and mortality of blunt thoracic aortic injury: a population-based analysis.
abstract: BACKGROUND
  In the last decade, CT angiography has become the dominant diagnostic modality for blunt aortic injury and endovascular repair has become the leading aortic repair strategy. The impact of these shifts on incidence, aortic repair rate, and mortality remains poorly characterized. Our objective was to perform a population-based analysis of secular trends in the incidence, management, and in-hospital mortality of blunt thoracic aortic injury.
  
  
  METHODS
  From the population-based Canadian National Trauma Registry, we identified a cohort of all adults hospitalized between April 2002 and March 2010 with a diagnosis of thoracic aortic injury after blunt trauma. Trends over time in the incidence of hospitalization, frequency and type of aortic repair, as well as risk-adjusted in-hospital mortality, were evaluated.
  
  
  RESULTS
  A total of 487 incident cases of blunt thoracic aortic injury were identified. During the study period, the incidence of hospitalization for blunt thoracic aortic injury remained stable (trend p = 0.16). Although the proportion of repairs undertaken via an endovascular approach increased (11% to 78% of repairs; trend p < 0.001), the frequency of any repair (endovascular or open) declined (55% to 36%; trend p = 0.003). Across all patients, when controlling for age, sex, mechanism of injury, and presence of severe extrathoracic injuries, mortality remained unchanged during the study period (odds ratio = 0.92 per 1 year; 95% CI, 0.82-1.03). However, in patients managed nonoperatively, risk-adjusted mortality decreased over time (odds ratio = 0.85 per 1 year; 95% CI, 0.80-0.98).
  
  
  CONCLUSIONS
  The increasing frequency of patients managed nonoperatively and decreasing risk-adjusted mortality in these patients suggests that defining the evolving role of nonoperative management should be a major focus of research in the endovascular era.
authors.affiliation: Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. charles.demestral@mail.utoronto.ca
authors.forename: Charles
authors.initials: C
authors.lastname: de Mestral
authors.forename: Andrew
authors.initials: A
authors.lastname: Dueck
authors.forename: Sunjay S
authors.initials: SS
authors.lastname: Sharma
authors.forename: Barbara
authors.initials: B
authors.lastname: Haas
authors.forename: David
authors.initials: D
authors.lastname: Gomez
authors.forename: Mavin
authors.initials: M
authors.lastname: Hsiao
authors.forename: Andrea
authors.initials: A
authors.lastname: Hill
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013898:Thoracic Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy