Screening for aortic injury with chest radiography and clinical factors

Kirkham, Jared R.; Blackmore, C. Craig

doi:10.1007/s10140-007-0636-7

Cited by 18 publications

(9 citation statements)

References 20 publications

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“…The greater the blunt trauma force the higher the index of suspicion for TAI should be. 140 Initial plain chest X-rays have a significant false negative rate in patients with TAI. Consequently, once aortic…”

Section: Iib B 104mentioning

confidence: 99%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

957

259

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Section: Iib B 104mentioning

confidence: 99%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

957

259

View full text Add to dashboard Cite

show abstract

“…Despite its relatively poor diagnostic accuracy [8–10] with significantly low specificity, it had been found to be the most powerful radiographic tool and improved specificity had been observed with the use of left mediastinal width (LMW) and mediastinal width ratio (MWR) [11]. Nevertheless, results from past literatures mainly focused on traumatic aortic rupture [12] but seldom on nontraumatic thoracic aortic rupture or aortic dissection which is far more common but often less emphasized with little attention received. In addition, the impact of posteroanterior (PA) and anteroposterior (AP) chest radiograph on mediastinal measurement was not well established and studied.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection

et al. 2012

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We aimed to explore the diagnostic accuracy of various mediastinal measurements in determining acute nontraumatic thoracic aortic dissection with respect to posteroanterior (PA) and anteroposterior (AP) chest radiographs, which had received little attention so far. We retrospectively reviewed 100 patients (50 PA and 50 AP chest radiographs) with confirmed acute thoracic aortic dissection and 120 patients (60 PA and 60 AP chest radiographs) with confirmed normal aorta. Those who had prior history of trauma or aortic disease were excluded. The maximal mediastinal width (MW) and maximal left mediastinal width (LMW) were measured by two independent radiologists and the mediastinal width ratio (MWR) was calculated. Statistical analysis was then performed with independent sample t test. PA projection was significantly more accurate than AP projection, achieving higher sensitivity and specificity. LMW and MW were the most powerful parameters on PA and AP chest radiographs, respectively. The optimal cutoff levels were LMW = 4.95 cm (sensitivity, 90 %; specificity, 90 %) and MW = 7.45 cm (sensitivity, 90 %; specificity, 88.3 %) for PA projection and LMW = 5.45 cm (sensitivity, 76 %; specificity, 65 %) and MW = 8.65 cm (sensitivity, 72 %; specificity, 80 %) for AP projection. MWR was found less useful and less reliable. The use of LMW alone in PA film would allow more accurate prediction of aortic dissection. PA chest radiograph has a higher diagnostic accuracy when compared with AP chest radiograph, with negative PA chest radiograph showing less probability for aortic dissection. Lower threshold for proceeding to computed tomography aortogram is recommended however, especially in the elderly and patients with widened mediastinum on AP chest radiograph.

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“…The presence of ≤2 predictors inferred a TAI risk of <1 per cent . However, a subsequent evaluation of the rule concluded that the rule was not clinically useful, and found that only four of the composite variables were in fact significant predictors of TAI …”

Section: Resultsmentioning

confidence: 99%

External validation of the traumatic aortic injury score

et al. 2017

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Aim: Traumatic aortic injury (TAI) is a serious complication of blunt chest trauma. The traumatic aortic injury score (TRAINS) is a clinical tool for risk determination, with patients scoring <4 considered low risk. The aim of the present study was to determine the sensitivity of TRAINS on a population of blunt trauma patients with TAI at an Australian major trauma centre. Patients and Methods: Patients diagnosed with thoracic TAI between 2006 and 2014 were identified from an institutional registry. Radiological studies (chest X-ray) were reviewed, while blood pressure on arrival to hospital was extracted from the registry. Using abbreviated injury scale codes, the presence of the five associated injuries included in the TRAINS model was determined. Results: A TRAINS ≥4 was observed in 28 out of 63 cases, with complete data available (sensitivity = 44.4 per cent; 95 per cent confidence interval: 32.8-56.7), with minimum and maximum possible sensitivities of 42.4 per cent and 47 per cent, respectively, as determined by two-way sensitivity analysis. Conclusions: This independent external validation of the TRAINS concluded a poor sensitivity for excluding TAI in the blunt chest trauma population. In the absence of reliable predictive tools, a low threshold for thoracic computed tomography imaging and clinical gestalt remain essential tools for the early diagnosis of TAI.

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Screening for aortic injury with chest radiography and clinical factors

Cited by 18 publications

References 20 publications

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection

External validation of the traumatic aortic injury score

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