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Identification of Trauma Patients at Risk of Thoracic Aortic Tear by Mechanism of Injury

Horton, Tristram G. BSc; Cohn, Stephen M. MD; Heid, Michael P. DO; Augenstein, Jeffrey S. MD, PhD; Bowen, Jami C. RN, BS; McKenney, Mark G. MD; Duncan, Robert C. PhD

The Journal of Trauma: Injury, Infection, and Critical Care: June 2000 - Volume 48 - Issue 6 - p 1008-1014
Annual Meeting Articles
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Objective We sought to identify potential measurable on-scene information that would assist clinicians in the identification of patients at risk for thoracic aortic tear (AT) after vehicular trauma.

Methods Data were prospectively collected at the scene of 295 motor vehicle crashes from 1995 to 1999. There were 34 cases (12%) with AT. Scene data consisted of vehicle maximal crush, maximal intrusion into the occupant compartment, change in velocity (Delta V) and principal direction of force. Thoracic aortic injuries were confirmed radiographically or at autopsy. Crash factors were analyzed for correlation with AT by logistic regression.

Results Delta V ≥ 20 mph and near-side impact were the factors having the strongest correlation with thoracic aortic injury. Delta V ≥ 20 mph (n = 32 with AT) had an odds ratio = 6.4, (p < 0.01). Near impact (n = 20 with AT) had an odds ratio = 2.3, (p < 0.05) and intrusion ≥ 15 inches had an odds ratio = 3.2, p < 0.05. The sensitivity, specificity, and accuracy of the presence of near impact, Delta V ≥ 20 mph, or both, were 100%, 34%, and 64%. The positive and negative predictive values were 16% and 100%, respectively. There was no relationship of AT to use of seat belts or airbags.

Conclusion Thoracic aortic injury after vehicular collision can be reliably excluded if near-impact, Delta V ≥ 20 mph, or intrusion ≥ 15 inches are not present. Mechanism of injury in the form of crash scene information may aid clinicians in identifying individuals at risk for thoracic aortic tear after vehicular trauma.

Address for reprints: Stephen M. Cohn, MD, Ryder Trauma Center, UM/JM Medical Center, Daughtry Family Department of Surgery, 1800 N.W. 10th Avenue, Suite T-227, Miami, FL 33136; email: stephen.cohn@miami.edu.

Submitted for publication September 25, 1999.

Accepted for publication March 1, 2000.

William Lehman Injury Research Center, Ryder Trauma Center, Miami Florida.

Presented at the 59th Annual Meeting of the American Association for the Surgery of Trauma, September 16–18, 1999, Boston, Massachusetts.

© 2000 Lippincott Williams & Wilkins, Inc.