Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort
Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort
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DOI：
10.1016/j.ejvs.2021.09.043
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发表时间：
2022-03-15
影响因子：
5.7
通讯作者：
Hamada, Sophie R.
中科院分区：
文献类型：
--
作者：
Boutin, Louis;Caballero, Marie-Josee;Hamada, Sophie R.
目的：钝性创伤性主动脉损伤（BTAI）在严重创伤患者中是罕见的，但可能致命。这项工作的目的是对欧洲国家这些患者的临床和外科治疗进行流行病学分析。方法：这是一个多中心，一项回顾性研究，使用法国国家创伤登记处和国家统一医院出院数据库中前瞻性收集的数据，这些数据来自10个创伤中心，法国主要终点是BTAI的患病率。次要终点集中在按时间顺序损伤的特点，管理，和patient outcome.Results：209例患者被纳入，平均年龄为43 +/- 19岁，168（80%）是男性。入院时计算的BTAI患病率为1%（162/15094）（BTAI入院/所有创伤）。诊断时间随着主动脉损伤的严重程度和患者的临床严重程度而增加（1级：94 [74，143]分钟至4级：154 [112，202]分钟，p = 0.020）。67例患者（32%）未接受手术治疗。在接受治疗的患者中，130例（92%）接受了血管内治疗，14例（10%）接受了开放手术（2例合并），123例（85%）在最初24小时内接受了治疗。总死亡率为20%，死亡原因为出血性休克（69%）。根据主动脉损伤的严重程度，死亡率增加，从1级的6%增加到4级的65%（p <0.001）。26例（18.3%）患者接受腔内主动脉修复术治疗的并发症。结论：BTAI患病率在入院时是低的，但发生在严重的高速创伤患者和那些临床高度怀疑严重出血。休克与高级别主动脉损伤和诊断时间增加的相关性表明，需要优化早期复苏，以最大限度地缩短治疗时间。血管内治疗已被确立为参考治疗，占BTAI介入治疗选择的90%以上。
Objective: Blunt traumatic aortic injury (BTAI) in severe trauma patients is rare but potentially lethal.The aim of this work was to perform a current epidemiological analysis of the clinical and surgical management of these patients in a European country.Methods: This was a multicentre, retrospective study using prospectively collected data from the French National Trauma Registry and the National Uniform Hospital Discharge Database from 10 trauma centres in France. The primary endpoint was the prevalence of BTAI. The secondary endpoints focused chronologically on injury characteristics, management, and patient outcomes.Results: 209 patients were included with a mean age of 43 +/- 19 years and 168 (80%) were men. The calculated prevalence of BTAI at hospital admission was 1% (162/15 094) (BTAI admissions/all trauma). The time to diagnosis increased with the severity of aortic injury and the clinical severity of the patients (grade 1: 94 [74, 143] minutes to grade 4: 154 [112, 202] minutes, p = .020).This delay seemed to be associated with the intensity of the required resuscitation. Sixty seven patients (32%) received no surgical treatment. Among those treated, 130 (92%) received endovascular treatment, 14 (10%) open surgery (two were combined), and 123 (85%) were treated within the first 24 hours. Overall mortality was 20% and the attributed cause of death was haemorrhagic shock (69%). Mortality was increased according to aortic injury severity, from 6% for grade 1 to 65% for grade 4 (p < .001). Twenty-six (18.3%) patients treated by endovascular aortic repair had complications.Conclusion: BTAI prevalence at hospital admission was low but occurred in severe high velocity trauma patients and in those with a high clinical suspicion of severe haemorrhage. The association of shock with high grade aortic injury and increasing time to diagnosis suggests a need to optimise early resuscitation to minimise the time to treatment. Endovascular treatment has been established as the reference treatment, accounting for more than 90% of interventional treatment options for BTAI.