Journal Article

Treatment of blunt thoracic aortic injury in Germany—Assessment of the TraumaRegister DGU

Lefering, Rolf, Andruszkow, Hagen, Keschenau, Paula, Kotelis, Drosos, Barbati, Mohammad E., Hildebrand, Frank, Jacobs, Michael J., Gombert, Alexander, Storck, Martin, Greiner, Andreas, Grommes, Jochen, Pape, Hans-Christoph

2017

Overview

Using the data delivered by the German Trauma Register DGU® from 2002 till 2013, the value of different therapies of blunt thoracic aortic injury (BTAI) in Germany was analyzed. Prospectively collected data of patients suffering from BTAI were retrospectively analyzed with focus on the different treatment modalities for grade I-IV injuries. 821 patients suffering from BTAI were identified: 51.6% (424) grade I injury, 35.4% (291) grade II or III injury and 12.9% (106) grade IV injury (77.5% men [44.94 ± 20.6 years]). The main patterns of injury were high- speed accidents and falls (78.0% [n = 640], 21.8% [n = 171] respectively). Significant differences between grade I and grade II/III as well as IV injuries could be assessed for the incidence of cardiopulmonary resuscitation, a Glasgow Coma Scale score below 8 and a systolic blood pressure below 90 mmHg (p-value: <0.001). In the primary admission subgroup, 44.1% (197/447) of the patients received best medical treatment, 55.9% received surgical intervention (250/447): Thereof 37.2% (93/250) received open surgery and 62.8% (147/250) had been treated by endovascular means. Significantly lower 24-h- and in-hospital-mortality rates were encountered after endovascular treatment for all gradings of BTAI (p-value: <0.001). Yet this subgroup of patients showed the lowest incidence of further severe injuries and cardiac arrest. Endovascular therapy became the treatment of choice for BTAI in Germany. Patients who have been treated by surgical means showed the highest survival rate, especially endovascular therapy showed a favorable low mortality rate.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Aged / Aneurysms / Aorta / Aorta, Thoracic - injuries / Aorta, Thoracic - surgery / Blood pressure / Cardiovascular system / Coma / Coronary vessels / Data analysis / Data collection / Documentation / Emergency medical care / Endovascular Procedures / Falls / Female / Germany - epidemiology / Glasgow Coma Scale / Health services / Heart diseases / Hospital Mortality / Hospitals / Humans / Incidence / Injuries / Injury analysis / Intensive care / Intervention / Laboratories / Male / Medical treatment / Medicine / Medicine and Health Sciences / Men / Middle Aged / Mortality / Patients / People and Places / Quality / Resuscitation / Retrospective Studies / Risk Factors / Sepsis / Subgroups / Surgery / Survival / Survival Rate / Therapy / Thoracic Injuries - epidemiology / Thoracic Injuries - surgery / Thorax / Trauma / Treatment Outcome / Vascular surgery / Wounds, Nonpenetrating - epidemiology / Wounds, Nonpenetrating - surgery / Young Adult