Retrospective Review on the Management of Blunt Aortic Injury at a Level I Trauma Community Hospital from 2003 to 2016

Delquis Mendoza, Mark Walker, Stanston Spence, Philip Ramsay, Katherine Kohler, Amy Wyrzykowski, Vernon Henderson, Walaya Methodius, James Poindexter, Marshall Lutske and Jonathan Nwiloh

Department of General Surgery, Wellstar Atlanta Medical Center, USA

^*Correspondance to: Delquis Mendoza 

 PDF  Full Text DOI: 10.25107/2474-1647.2568

Abstract

Introduction: The management of blunt aortic injury has changed dramatically over the past three decades. An endovascular approach is now recommended whenever possible. Literature review shows that high volume centers tend to have shorter hospital LOS and fewer complications compared to low volume centers. However, there is no significant difference in mortality. We performed this retrospective study to take a snapshot of our experience on BAI management between the years of 2003 to 2016. Methods: Trauma patients managed at our community hospital with blunt aortic injury over a 13- year period were reviewed. The patient sample was derived from the trauma registry. 53 patients who received specific treatment of the aortic injury underwent statistical analysis. Results: For the 53 patients analyzed, their mean ISS was 30 and their mean hospital length of stay was 22 days. The average time to endovascular repair was 1.94 days with a range of 1 to 6 days. 32 out of the 53 patients underwent endovascular repair within 24 h of admission. Orthopedic injuries were the most common associated injuries followed by chest trauma. Close to 70% of the 53-patient cohort were discharged either to home or to an acute rehab facility. Two patients were declared brain dead; three died from cardiac arrest, and one patient died following withdrawal of care as requested by family. In-hospital mortality was 11.32%. Conclusion: In reviewing our data, patients who did not survive following endovascular repair had severe closed head injuries and ongoing hemorrhage from multisystem organ injuries. It is possible these patients would not have survived even if they were treated at centers with much higher number of cases per year. Timing of endovascular repair could be another factor affecting mortality. Most of our patients had interventions within 24 h of admission. As we plan for the future, we will closely monitor grading of injuries and timing of endovascular repair.

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Cite the article

Mendoza D, Walker M, Spence S, Ramsay P, Kohler K, Wyrzykowski A, et al. Retrospective Review on the Management of Blunt Aortic Injury at a Level I Trauma Community Hospital from 2003 to 2016. Clin Surg. 2019; 4: 2568..