Malgor Rafael D, Bilfinger Thomas V, McCormack Jane, Tassiopoulos Apostolos K
Division of Vascular Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY.
Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY.
Ann Vasc Surg. 2015 Apr;29(3):502-10. doi: 10.1016/j.avsg.2014.10.012. Epub 2014 Nov 22.
Blunt traumatic aortic injury (BTAI) is of very rare occurrence in adolescents. The purpose of our study was to assess the clinical presentation and treatment outcomes of BTAI in this subset of patients.
We reviewed prospective data of 18 patients who were 20 years or younger with BTAI among 28,000 trauma patients from January 1993 to December 2011. Outcomes of interest were the trends on the type of repair (nonoperative [NOP], open repair [OR], or endovascular treatment [ET]) and the impact of concomitant injuries using the Injury Severity Score (ISS) on early morbidity and mortality.
Thirteen (72%) patients with BTAI were male with a cohort median age of 16 ± 3 years. The mechanism of trauma was car accident in 12 patients, pedestrian struck by car in 5, and motorcycle crash in 1. The total ISS was 46.2 ± 15.3 being the highest score of the thoracic component (4.6 ± 0.6) followed by the head score (4 ± 1.2). Two (11%) patients were pronounced dead in the emergency department and other 2 succumbed within 24 hr from admission. Of those 14 (78%) patients who survived longer than 24 hr, the ISS was significantly lower compared with those pronounced dead earlier (37.8 ± 10.7 vs. 59.6 ± 11.6; P = 0.0009). Ten patients (71%) underwent OR, 3 (17%) ET, and other 2 (28%) patients were treated nonoperatively. The ISS was similar among all 3 treatment groups (OR: 33 ± 8 vs. ET: 53 ± 9 vs. NOP: 51 ± 6; P = nonsignificant). No paraplegia or renal failure was noted in either ET or OR group. In-hospital and overall mortality were 21% and 39%. Of those who survived hospitalization, 8 (73%) patients were discharged home and 3 (27%) to a rehabilitation center.
The incidence of BTAI is very low in adolescents. Mortality rate is considerable even in young patients and it is associated with high ISS and degree of aortic wall disruption. Young patients with BTAI who survive hospitalization have a lower ISS and are often discharged home rather than to a rehabilitation facility.
钝性创伤性主动脉损伤（BTAI）在青少年中极为罕见。我们研究的目的是评估该类患者中BTAI的临床表现及治疗结果。
我们回顾了1993年1月至2011年12月期间28000例创伤患者中18例年龄20岁及以下的BTAI患者的前瞻性数据。关注的结果包括修复类型（非手术治疗[NOP]、开放修复[OR]或血管内治疗[ET]）的趋势，以及使用损伤严重程度评分（ISS）评估伴随损伤对早期发病率和死亡率的影响。
13例（72%）BTAI患者为男性，队列中位年龄为16±3岁。创伤机制为车祸12例，行人被汽车撞击5例，摩托车事故1例。ISS总分46.2±15.3，其中胸部损伤评分最高（4.6±0.6），其次是头部损伤评分（4±1.2）。2例（11%）患者在急诊科被宣布死亡，另外2例在入院后24小时内死亡。在那些存活超过24小时的14例（78%）患者中，ISS显著低于早期宣布死亡的患者（37.8±10.7 vs. 59.6±11.6；P = 0.0009）。10例（71%）患者接受了OR治疗，3例（17%）接受了ET治疗，另外2例（28%）患者接受了非手术治疗。所有3个治疗组的ISS相似（OR组：33±8 vs. ET组：53±9 vs. NOP组：51±6；P = 无显著性差异）。ET组和OR组均未发现截瘫或肾衰竭。住院死亡率和总死亡率分别为21%和39%。在存活出院的患者中，8例（73%）患者出院回家，3例（27%）转至康复中心。
青少年BTAI的发病率极低。即使是年轻患者，死亡率也相当高，且与高ISS和主动脉壁损伤程度相关。存活出院的年轻BTAI患者ISS较低，通常出院回家而非转至康复机构。
