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

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

OBJECTIVEWe 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. METHODSData were prospectively collected at the scene of 295 motor vehicle crashes from 1995 to 1999....

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Bibliographic Details
Published in:The journal of trauma Vol. 48; no. 6; pp. 1008 - 1014
Main Authors: Horton, Tristram G., Cohn, Stephen M., Heid, Michael P., Augenstein, Jeffrey S., Bowen, Jami C., McKenney, Mark G., Duncan, Robert C.
Format: Journal Article
Language:English
Published: United States Lippincott Williams & Wilkins, Inc 01-06-2000
Subjects:
Accidents, Traffic - statistics & numerical data
Adolescent
Adult
Aged
Aged, 80 and over
Data Collection
Female
Humans
Logistic Models
Male
Middle Aged
Prospective Studies
Radiography
Risk Factors
Thoracic Arteries - diagnostic imaging
Thoracic Arteries - injuries
Wounds and Injuries - etiology
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Summary:OBJECTIVEWe 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. METHODSData 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. RESULTSDelta 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. CONCLUSIONThoracic 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.
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ISSN:0022-5282
1529-8809
DOI:10.1097/00005373-200006000-00003