title: Aortic dissection in hospitalized children and young adults: a multiinstitutional study.
abstract: OBJECTIVE
  To describe the incidence, characteristics, and outcomes of hospitalized children and young adults with aortic dissection (AD).
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  The Pediatric Health Information System database, a multiinstitutional administrative database.
  
  
  METHODS
  All index cases of patients <30 years old hospitalized with AD between January 2004 and June 2011.
  
  
  METHODS
  The primary outcome measure was inpatient mortality.
  
  
  RESULTS
  Of 3 800 964 hospitalizations, AD was identified in 124 (<1%), accounting for 110 patients (69% male, P = .003) at a median age of 12.9 (interquartile range 3.9-16.8) years with a bimodal distribution in infancy and late adolescence. Associated diagnoses included congenital heart disease (CHD) (38%), trauma (24%), connective tissue disease (CTD) (16%), and isolated hypertension (HTN) (8%). Common CHD diagnoses included aortic arch (24%) and valve (21%) disease, hypoplastic left heart syndrome (10%), and transposition of the great arteries (10%). CHD patients were younger and more likely to undergo inpatient non-AD-related cardiovascular procedures compared with other diagnostic groups (P < .001 for both). Marfan and Ehlers-Danlos syndrome were present in 72% and 11% of CTD patients, respectively. Overall in-hospital mortality in patients with AD was 13% compared with 1% in the database population (odds ratio 12.0, 95% confidence interval 6.9-21.1). By diagnostic category, mortality was 22% in HTN, 22% in CTD, 12% in CHD, and 4% in trauma.
  
  
  CONCLUSIONS
  AD is rare in children and young adults but most commonly occurs in CHD and CTD and in males. AD is associated with high inpatient mortality.
authors.affiliation: Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex, USA.
authors.forename: Pirouz
authors.initials: P
authors.lastname: Shamszad
authors.forename: Jeff N
authors.initials: JN
authors.lastname: Barnes
authors.forename: Shaine A
authors.initials: SA
authors.lastname: Morris
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003240:Connective Tissue Diseases / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000401:mortality; D015994:Incidence; D007297:Inpatients; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality; D055815:Young Adult
keywords: Aortic Disease; Hospital Utilization; Mortality; Pediatrics; Risk Factors