title: Etiology of fatal thoracic aortic injuries: Secondary data analysis.
abstract: OBJECTIVE
  Motor vehicle crashes remain a leading cause of death in the United States (US). Thoracic aortic dissection due to blunt trauma remains a major injury mechanism, and up to 90% of these injuries result in death on the scene. The objective of this study is to understand the modern risk factors and etiology of fatal thoracic aortic injuries in the current US fleet.
  
  
  METHODS
  Using a unique, linked, Fatality Analysis Reporting System (FARS) and Multiple Cause of Death (MCOD) database from 2000-2010, 144,169 drivers over 16 years of age who suffered fatal injuries were identified. The merged database provides an unparalleled fidelity for identifying thoracic aortic injuries due to motor vehicle accidents. Thoracic aortic injuries were defined by ICD-10 codes S250. Univariate and multivariate logistic regression models for presence of any thoracic aortic injuries were fitted. Age, gender, BMI weight categories, vehicle class, model year, crash type/direction, severity of crash damage, airbag deployment location, and seatbelt use, fatal injury codes, and location of injury were considered. Odds ratios (OR) and corresponding 95% confidence intervals (95%CI) are calculated.
  
  
  RESULTS
  There were 2953 deaths (2.10%) related to thoracic aortic injuries that met the inclusion criteria. Nearside crashes were associated with an increased odds (OR = 1.42, 1.1-1.83), while rollover crashes (OR =.44,.29-.66) were associated with a reduced odds of fatal thoracic aortic injury. Using backward selection on the full multivariate model, the only significant model effects that remained were vehicle type, crash type, body region, and injury type.
  
  
  CONCLUSIONS
  The increased prevalence of fatal thoracic aortic injury in nearside crashes, increasing age, and vehicle type provide some insight into the current US fleet. Important factors, including model year, had significantly lower levels of the injury in univariate analysis, demonstrating the effect of safety improvements in newer model vehicles. Further study of this fatal injury is warranted, including comparisons of those who survive the injury.
authors.affiliation: a Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , Florida.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Sznol
authors.affiliation: a Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , Florida.
authors.forename: Tulay
authors.initials: T
authors.lastname: Koru-Sengul
authors.affiliation: b Impact Research, LLC , Columbia , Maryland.
authors.forename: Jill
authors.initials: J
authors.lastname: Graygo
authors.affiliation: b Impact Research, LLC , Columbia , Maryland.
authors.forename: Denis
authors.initials: D
authors.lastname: Murakhovsky
authors.affiliation: b Impact Research, LLC , Columbia , Maryland.
authors.forename: George
authors.initials: G
authors.lastname: Bahouth
authors.affiliation: a Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , Florida.|c Department of Surgery , University of Miami Miller School of Medicine , Miami , Florida.
authors.forename: Carl I
authors.initials: CI
authors.lastname: Schulman
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D001013:Aorta, Thoracic / Q000293:injuries*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D012307:Risk Factors; D012622:Seat Belts / Q000706:statistics & numerical data; D013898:Thoracic Injuries / Q000209:etiology* / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: FARS; MCOD; motor vehicle accident; thoracic aortic injury