WHAT THIS PAPER ADDSA complete analysis was performed of the clinical pathway from pre-hospital management to discharge and long term follow up of patients with blunt traumatic aortic injury (BTAI). Endovascular treatment is confirmed as the reference treatment growing to more than 90% of treated patients with a 18.3% complication rate. The time to diagnosis was longer for the more severe BTAI injuries, probably given the intensity of resuscitation required, suggesting a need to minimise delays in early management. These recent epidemiological data on the management of BTAI patients could be used as a reference for future comparative studies.

Background: Blunt aortic trauma injury (BTAI) in severe trauma patients is rare but lethal and is the second leading cause of death after brain damage. Development in automotive technology have reduced mortality at the scene of the accident and increased hospital admissions for patients with aortic injury. The aim of this work was to proceed with an epidemiologic analysis of BTAI on a French cohort.Methods: This is a multicentric retrospective study including patients admitted between 2013 and 2018 in 10 French trauma centers and participating in the Traumabase® registry. Demographic, diagnostic and therapeutic data were collected. Severity of aortic injuries was classified according to the Vancouver grades. Results: 209 patients were included, mean age was 43 years (19) and 168 (80%) were men. They had a Red Flag of 2[1-3], an injury severity score of 39 (18.3) and several associated lesions: 4[3-5]. The calculated prevalence of BTAI was 1%.Mechanisms associated with BTAI were high kinetic accidents, with severe thoracic injury. Patients presented with high clinical suspicion for severe hemorrhage. The time to diagnosis increased with the severity of aortic injury (grade 1: 94[74-143] minutes, grade 2: 129[106-143] minutes, grade 3: 117[100-170] minutes, grade 4: 154[112-202] minutes, p=0.02). Overall mortality was 20% and increased with the severity of aortic injury (grades 1: 6%, grades 2: 12%, grades 3: 22% et grades 4: 65%, p<0.001). The delay before death was 1,5[1-4.7] days (grade 1: 2[1.5-3] days, grade 2: 12[1-42.7] days, grade 3: 2[1-6.2] days, grade 4: 1[1-1.5] days, p=0.003).Among deceased patients, 16 (38%) had hemorrhagic shock, 13 (31%) had post-hemorrhagic multiple organ failure, 5 (12%) had cerebral cause, and 8 (19%) had septic shock. Conclusions: Patients with BTAI presented severe trauma with multiple associated injuries, were victims of a high kinetic accident and had an overall 20% mortality with a 65% mortality rate for grade 4 patients. They died of hemorrhagic shock in more than 2/3 of the cases and received endovascular treatment in 2/3 of the case.Trial registration: Advisory Committee for Information Processing in Health Research (CCTIRS, 11.305 bis). National Commission on Informatics and Liberties Data protection agency (CNIL, 911461 and 2211878). National institutional review board requirements (Comité de Protection des Personnes Paris VI, Paris, France).