Determining Risk of Traumatic Aortic Injury

Abstract

The probability of traumatic aortic injury can be estimated from the injury index prediction rule. Because cost-effectiveness of various imaging strategies depends on probability of injury, the prediction rule can guide imaging selection.

Low-impact scenarios may account for two-thirds of blunt traumatic aortic rupture

“…These cases were subclassified into four proposed risk groups for aortic injury—frontal impact non-seatbelted (FNSB), frontal impact seatbelted (FSB), lateral impact victim on struck side (LSS) and lateral impact victim on non-struck side (LNSS). These groups have been found to be the highest risk groups for BTAR in multiple previous studies 2 8 9. In the case of lateral impacts, seatbelt use was not used as a filter as the specific design of a seatbelt is to engage when there is a significant linear acceleration forwards, to avoid impact with the steering column.…”

“…In frontal impacts, the risk of BTAI is increased when the victim does not use a seatbelt (RR=3.0 95% CI, p<0.001); similarly in lateral impacts, the risk of BTAI is increased when the victim is on the side of impact (RR=1.3 95% CI, p 0.5) 7. Blackmore et al proposed a risk scoring scheme for BTAI taking account of number of body regions injured, haemodynamics, and age and sex 9. To date, however, no specific reports have been found in the literature assessing the influence of impact speed on the incidence of BTAI.…”

Evaluation of patients diagnosed with acute blunt aortic injury and their bedside plain chest radiography in the emergency department: A retrospective study

“…[5,6] Blackmore et al described 7 risk factors related to aortic injury including age >50 years, BP <90 mmHg and thoracic trauma. [13] In a multicenter study, Mosquera et al (82 aortic injuries from years 1980-2010) defined a traumatic aortic injury score (TRAINS) that included these criteria: widened mediastinum, hypotension, hemothorax, contusion, left scapular fracture. [12] Mosquera et al found mean RTS to be 5.98 and 34.2% of cases had GCS <9.…”

Derivation of a Clinical Decision Rule to Exclude Thoracic Aortic Imaging in Patients With Blunt Chest Trauma After Motor Vehicle Collisions

“…7,8 Two recent studies attempted to define subsets of patients who do not require imaging of the aorta after a motor vehicle collision (MVC). 9,10 In the first study, the authors suggested that some patients may be reliably excluded from having TAI based on mechanism alone. 9 In the second study, a seven-point injury index was derived and included the patient's age, whether restraints were used, and the existence of coexisting injuries to exclude the presence of TAI.…”

“…9 In the second study, a seven-point injury index was derived and included the patient's age, whether restraints were used, and the existence of coexisting injuries to exclude the presence of TAI. 10 Unfortunately, both studies require acquisition of data that is often subjective, unreliable, initially unavailable, or unobtainable.…”