title: The effect of loss to follow-up on treatment of blunt traumatic thoracic aortic injury.
abstract: OBJECTIVE
  Loss to follow-up (LTFU) can be a major difficulty for any clinical research study. The objective of this systematic review was to assess the extent of LTFU and its potential effect in studies of adult trauma patients with blunt thoracic aortic injuries (BTAIs).
  
  
  METHODS
  Studies comparing management of BTAIs were systematically reviewed. Duplicate independent review was used for study selection, data abstraction, and critical appraisals.
  
  
  RESULTS
  Thirty-six studies were included for synthesis, of which 94.1% applied a retrospective cohort design to prospective institutional databases. The mean LTFU at 1 year was 26.5% ± 31.6% for endovascular repair and 20.6% ± 34.2% for open repair groups. Not having a surgical/interventional specialist as a first or senior author was associated with a 39.7% higher LTFU at 1 year (P = .002). Studies with a higher risk of bias, later publication year, or North American origin were associated with a significantly higher risk for LTFU at 1 year (P ≤ .001). Nearly half of included studies assessed in-hospital outcomes exclusively. Only 38.2% explicitly reported LTFU data. Eight studies explicitly described the method of dealing with LTFU: eight used survival analysis and one used a national Social Security Death Index. Sensitivity analyses using plausible worst-case LTFU scenarios resulted in 14% to 17% of studies changing direction of effect.
  
  
  CONCLUSIONS
  There is significant LTFU in trauma studies comparing operative methods for BTAIs. LTFU is generally handled and reported suboptimally, and sensitivity analyses suggest that study results are sensitive to differential LTFU. This has implications for the evidence-based choice of the operative method. Some protective factors that may aid in reducing LTFU were identified, one of which was involvement of a surgical or interventional specialist as a key author.
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Biniam
authors.initials: B
authors.lastname: Kidane
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Madelaine
authors.initials: M
authors.lastname: Plourde
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sami A
authors.initials: SA
authors.lastname: Chadi
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada.
authors.forename: Alla
authors.initials: A
authors.lastname: Iansavitchene
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Maureen O
authors.initials: MO
authors.lastname: Meade
authors.affiliation: Department of Surgery, Western University, London, Ontario, Canada; Trauma Services, London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Neil G
authors.initials: NG
authors.lastname: Parry
authors.affiliation: Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: thomas.forbes@uhn.ca.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Forbes
mesh_terms: D001013:Aorta, Thoracic / Q000293:injuries / Q000601:surgery*; D016009:Chi-Square Distribution; D003627:Data Interpretation, Statistical; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D059012:Lost to Follow-Up; D016017:Odds Ratio; D012107:Research Design / Q000706:statistics & numerical data; D012307:Risk Factors; D013898:Thoracic Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D057772:Vascular System Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*